The Qualitative Report The Qualitative Report
Volume 19 Number 29 Article 1
7-21-2014
Uncovering ED: A Qualitative Analysis of Personal Blogs Managed Uncovering ED: A Qualitative Analysis of Personal Blogs Managed
by Individuals with Eating Disorders by Individuals with Eating Disorders
Jacqueline Gies
The Richard Stockton College of New Jersey
Sara Martino
The Richard Stockton College of New Jersey
, martinos@stockton.edu
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Recommended APA Citation Recommended APA Citation
Gies, J., & Martino, S. (2014). Uncovering ED: A Qualitative Analysis of Personal Blogs Managed by
Individuals with Eating Disorders.
The Qualitative Report
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(29), 1-15. https://doi.org/10.46743/
2160-3715/2014.1104
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Uncovering ED: A Qualitative Analysis of Personal Blogs Managed by Individuals Uncovering ED: A Qualitative Analysis of Personal Blogs Managed by Individuals
with Eating Disorders with Eating Disorders
Abstract Abstract
Previous studies have investigated the potential harmful effects of pro-eating disorder (ED) websites.
Websites, such as personal blogs, may contain eating disorder content that may hold important
information as well and must be considered. Fifteen blogs hosted by the site “Tumblr” were qualitatively
analyzed. Each blog owner was anonymous and all were female. Ten main themes were extracted using
grounded theory: interaction, negative self-worth, mind and body disturbances, pictures, eating disorders,
suicide, diet, exercise, stats, and recovery. Additional themes also appeared in the study. Results indicate
that although each individual blog is unique to its owner, common concepts existed among the majority.
The implications for the information in the ED blogs and directions for future research are discussed.
Keywords Keywords
Eating Disorders, Blogs, Online Support, Treatment
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The Qualitative Report 2014 Volume 19, Article 57, 1-15
http://www.nova.edu/ssss/QR/QR19/gies57.pdf
Uncovering ED: A Qualitative Analysis of Personal Blogs
Managed by Individuals with Eating Disorders
Jacqueline Gies and Sara Martino
The Richard Stockton College of New Jersey, Galloway, New Jersey, USA
Previous studies have investigated the potential harmful effects of pro-eating
disorder (ED) websites. Websites, such as personal blogs, may contain eating
disorder content that may hold important information as well and must be
considered. Fifteen blogs hosted by the site “Tumblr” were qualitatively
analyzed. Each blog owner was anonymous and all were female. Ten main
themes were extracted using grounded theory: interaction, negative self-
worth, mind and body disturbances, pictures, eating disorders, suicide, diet,
exercise, stats, and recovery. Additional themes also appeared in the study.
Results indicate that although each individual blog is unique to its owner,
common concepts existed among the majority. The implications for the
information in the ED blogs and directions for future research are discussed.
Keywords: Eating Disorders, Blogs, Online Support, Treatment
Introduction
Eating disorders remain a widespread silent battle that calls for awareness and
understanding. The National Eating Disorder Association (NEDA) provides an estimate
based off epidemiology information provided by Wade, Keski-Rahkonen, and Hudson (2011)
that about twenty million women and ten million men in the United States suffer from
anorexia nervosa, bulimia nervosa, binge-eating disorder, or an eating disorder not otherwise
specified (National Eating Disorder Association, 2013, Wade, Keski-Rahkonen, & Hudson,
2011). The National Institute of Mental Health provides detailed information on the
characteristics of anorexia, bulimia, and binge-eating disorder. Anorexia nervosa is
characterized by emaciation, an unwillingness to maintain a normal or healthy weight, intense
fear of gaining weight, distorted body image, a self-esteem that is heavily influenced by
perceptions of body weight and shape, denial of the seriousness of the low body weight, lack
of menstruation among females, and extremely restrictive eating. Symptoms of bulimia
nervosa include recurrent and frequent episodes of eating unusually large amounts of food
and feeling a lack of control over these episodes. Diagnostic criteria for bulimia include
bingeing episodes at least twice per week including compensatory behaviors (APA, 2013).
Compensatory behavior following the binge-eating consists of forced vomiting, excessive use
of laxatives or diuretics, fasting, excessive exercise, or a combination. Binge-eating disorder
is very similar to bulimia nervosa but without the compensation for the binge episodes
(National Institute of Mental Health, 2011).
Thirteen million Americans binge-eat, ten million women battle anorexia or bulimia,
and one million men battle anorexia or bulimia. Also, the number of eating disorder-related
hospitalizations in the USA has increased between 1999 and 2006. From 1999 to 2006 there
was an 18 percent overall increase, a 37 percent increase among men, and a staggering 119
percent increase among children under twelve years old. CNN also reports that 80 percent of
all ten year olds are afraid of being fat and 42 percent of all first through third grade girls
want to be thinner (CNN Health, 2012).
2 The Qualitative Report 2014
Development of ED
Eating disorders may develop for a variety of reasons. Six notable factors according
to research include culture, personal characteristics, emotional disorders, stress events or life
changes, biology, and family (Womenshealth, 2010). Tozzi, Sullivan, Fear, McKenzie, and
Bulik (2003) interviewed 70 women who were referred for inpatient treatment of anorexia
nervosa. They found that more than one-third (34.78%) of the patients they interviewed
highlight dysfunctional family as contribution to the onset of their disease. Following this
cause were weight loss and dieting (21.74%) and stress and frustration (20.29%) (2003).
Individuals diagnosed with anorexia nervosa and bulimia nervosa are likely to have a history
of behavioral abnormalities and internalization problems such as social withdraw and
depressive symptoms with complaints of nervousness, loneliness, inferiority, and guilt. With
regard to bulimic behaviors specifically, externalizing abnormalities were also reported with
more quarrels, emotional instability, jealousy, and attention seeking (Adambegan, Wagner,
Nader, Fernandez-Aranda, Treasure, & Karwautz, 2012). As a conclusion of their study,
anorexia nervosa and bulimia nervosa pathology were found to be relevant to high negative
affectivity, emotional instability, anxiety, depression, guilt, low self-esteem, and an
internalization of these factors.
Physical and mental health can be severely impacted by the onset and continuation of
eating disorders. There are several existing methods of eating disorder treatment that can
prove useful when weighing their effectiveness. Cognitive-behavioral therapy stands as the
treatment of choice for bulimia nervosa and binge-eating disorder, and family therapy is
supported as the leading approach for adolescents with anorexia (Wilson, Grilo, & Vitousek,
2007). Mindful eating may also prove to be beneficial among victims of bulimia nervosa,
binge-eating disorder, and anorexia nervosa. A case study was conducted on a 19 year old
college female referred to counseling in the community with a BMI (body mass index) of
17.9 and a daily restriction of 900-1,000 calories. The individual also engaged in one hour of
exercise per day. 15 weeks of therapy included mindful eating, which consists of in the
moment visualizations while eating food to focus on the eating and not on the negative self-
talk that accompanies the eating. After therapy was completed, her restriction declined and
her BMI and daily caloric intake increased (Albers, 2011). Intensive residential treatment
also exemplifies a successful treatment route for patients with anorexia nervosa and bulimia
nervosa in the United States (Brewerton & Costin, 2011a, 2011b). Brewerton and Costin
found that the majority of the 116 patients in the intensive residential care program showed
significant improvement at long-term follow up. Good outcome was defined as a return to
normal weight and resumption of menstruation. Intermediate outcome was defined as return
to normal weight or resumption of menstruation. 89 percent of those with anorexia had a
good or intermediate outcome about five years after discharge and 75 percent of bulimic
patients had a good or intermediate outcome about four years after discharge. Other research
indicates that there are more methods of support for ED, such as online support.
Online Support
Online support exists for victims of eating disorders in a variety of venues. A recent
statistic model indicates that as of June 30, 2012 51.8 percent of the North American
population, 273.8 million people, use the Internet (Internet World Stats, 2012). With little to
no social interaction, such as face to face encounters, it is not unlikely that an eating disorder
sufferer will turn to an interactive anonymous social support system. Positive affect was a
frequent theme found among a content analysis of five Yahoo! eating disorder-based
Jacqueline Gies and Sara Martino 3
discussion boards (Eichhorn, 2008). In this study, 20 percent of the messages reported
positive affect where users were encouraging others’ success.
Seeking online support for eating disorders such as through online chat rooms has its
consequences as well. The National Eating Disorder Association informs that many cases of
eating disorders are not reported for various reasons. The desire to keep the eating disorder a
secret may be one reason as to why many incidents and cases are not brought to the attention
of professionals. The National Institute of Mental Health states, in their study of 2, 980
people reporting eating disorder symptoms, that more than 50 percent of individuals with
eating disorders receive treatment for their emotional problems but less than 47 percent seek
treatment specific to their eating disorder (National Institute of Mental Health, 2007).
According to Rouleau and von Ranson’s 2011 study on the potential risk of pro-eating
disorder websites, individuals are not seeking other support and treatment because they share
tips on how to conceal their eating disorder symptoms. If the victim is able to hide his or her
signs of the disorder, that individual will likely avoid treatment and therapy as treatments for
eating disorders are often initiated by friends and family members. The Internet serves as an
outlet for the victim’s innermost thoughts while also concealing their identity. .
As Internet usage continues to grow so must the awareness of its activity. Eating
disorder activity is no exception. Much attention has been brought to the issue of cyber-
bullying and its devastating effects. Sugarman and Willoughby (2013) explain that advances
in technology are extensions of human behavior and culture. Violent behavior has been
altered due to this advancement in the increase of disinhibition. The anonymity that the
Internet provides removes some of the inhibition humans have in doing and saying things.
Although cyber-bullying and eating disorders have respectively different concepts, the
important similarity is that their role on the Internet can be just as harmful as their role
offline. Sugarman and Willoughby continue with this subject stating that social networking
websites permit considerable self-expression but also serve as an arena to harass, humiliate,
or threaten.
Online communication is also affecting the course of eating disordered behavior.
Some internet sites have been labeled “pro-ana” and “pro-mia” sites; indicating that the sites
will provide tips and tools for maintaining the disorder rather than provide support for
treating the disorder (Tierney, 2006). In a previous study on the dangers of online
communication regarding pro-anorexia websites and their implications for users,
practitioners, and researchers, Tierney explored individuals’ involvement in web-based
support groups. She notes that online interaction enables Internet users from all across the
globe to communicate about any given topic but some formats reinforce dysfunctional
practices and isolate individuals from society. Eating disorder interaction sites are a
protected resort where sufferers openly discuss what is happening to them, what is going on
in their lives to trigger their actions, and what dark thoughts lurk in the shadows of their
minds. The Internet for some may be an unofficial alternative to therapy.
Wilson, Peebles, Hardy, and Litt (2006) reported in their pilot study of pro-eating
disorder website usage in adolescents with eating disorders that the pro-ED sites serve a
number of functions. The possible functions include an eating disorder clique that has a
negative impact on body image and eating behaviors, a therapeutic environment where
anonymous expression of self is available, and a support system which overpowers face-to-
face interaction (2006). In conclusion to their study, the researchers found that the use of
pro-ED websites may have a negative impact on quality of life and could increase disordered
eating behaviors. Visitors of pro-ED sites also have exposure to new weight-loss and purging
techniques. Interpretation of website information can range depending on the viewer. The
writer’s intentions fluctuate from desperately needing an outlet and a feeling of belonging to
a community to the desire to compete with other eating disordered people. Brotsky and Giles
4 The Qualitative Report 2014
(2007) concluded to their study based on a covert online observation into a pro-ED website
that individuals participate based off of a desire to simply belong to a safe community with
members facing similar experiences. In a separate study conducted by Jett, LaPorte, and
Wanchisn (2010) on the impact of exposure to pro-ED websites on eating behavior in college
women, pro-ED websites may encourage or reinforce disordered eating behaviors.
Internet communication is important to look at in eating disordered behavior. Human
behavior is not easily predictable and no two people are exactly the same. This research
engages in a process of searching for common concepts portrayed by several individuals on
personal blog pages. The goal is to determine the content of these blogs and see what tips or
supports are being offered in the areas of prevention, treatment, education, and recovery of
eating disorders. Although each victim is different in their own respect, common concepts
will emerge throughout the content analysis linking the individual characteristics to common
themes in online eating disorder sites.
The goal of this study is to examine blogs and their content using a qualitative
approach. Grounded theory will be utilized in order to pull consistent themes from the blogs.
As explained by Chen and Boore (2009) in their description of this approach for their
exploration of using a synthesized technique for grounded theory in nursing research, the aim
of this particular approach is to discover patterns and understand how people define their
reality via social interactions.
Relatively little research is available on the existence of personal eating disorder blogs
as opposed to pro-ED websites. The present study offers awareness and a fresh theoretical
interpretation of the concepts collected from the data. This particular research addresses the
crucial need for investigation and inquiry into media pertaining to eating disorders, and more
specifically, to online blogging. Blogs can act as an interactive and anonymous online diary.
About one third of eating disorder sufferers ruminate about their stressful experiences. This
may suggest incomplete emotional processing (Schmidt, Bone, Hems, Lessem, & Treasure,
2002). The writer is given freedom by anonymous blogging to express ruminating feelings,
thoughts, and emotions about triggers, therapy, medications, doctor visits, and any other
haunting experience they could be subjected to. Lapinski (2006) notes in her content analysis
study of pro-ED blogs that the Web may be used as a tool for exchange of inaccurate
information and promotion of unhealthy or destructive behaviors.
Method
The study used grounded theory to produce a qualitative analysis of data content.
Specifically, the method of grounded theory has been employed in this study. Grounded
theory allows the researchers to look at a large amount of information, the personal blogs,
and compile the data into discrete categories based on themes that are found within the data.
This is a document analysis wherein each blog page acts as an anonymous diary. Although
each victim is different in their own respect, common concepts appeared throughout the
content analysis. Common concepts were coded line by line and put into piles based on
category construction (Corbin & Strauss, 1990). Satiation point was reached once no new
concepts emerged that led to additional categories of behavior. Concepts were selected for
inclusive line by line, as each blog entry contains information specific to eating disorder
behavior only.
Participants
Fifteen blogs were randomly selected for this study through the Tumblr site. Every
other blog site was identified and coded using Grounded Theory. No identifying information
Jacqueline Gies and Sara Martino 5
was exposed on the blog site, and the data used in the study was coded and used
anonymously. Two Additional blogs following the same procedure were analyzed to ensure
the reoccurrence of the common themes. All blog owners self-identified as female. No other
identifying information is available on the blog site as this is an anonymous forum for
individuals with eating disorders.
Procedure
IRB approval was obtained through a local college to seek out websites that contain
personal blogs about eating disorders. Blogs were selected through the Tumblr search engine
using the keyword “eating disorder.” Blogs were randomly selected from the results of the
keyword search conducted at a local college computer lab with no filters in place. Grounded
theory was implemented to produce a qualitative analysis of data content. Patterns were
discovered by use of grounded theory to relate similar content of each blog to common
discrete categories established throughout the study.
Phrases, images, blog entries, and statistics and descriptions of the blog owner were
analyzed through line by line analysis and placed into discrete categories according to
grounded theory techniques (Corbin & Strauss, 1990) Concepts were placed in related piles
line by line until saturation point was reach and no new categories emerged. Ten main
themes emerged and were reviewed by both authors of the study: interaction, negative self-
worth, mind and body disturbances, pictures, eating disorder, suicide, diet, exercise, stats, and
recovery. Other themes also appeared with less frequency, including trigger warnings,
positivity, sexuality, family, drugs, relationships, and art.
Results
In the sections to follow a brief overview is presented regarding the most common
themes found amongst fifteen qualitatively analyzed Tumblr blogs use a line by line sorting
process. The most frequently occurring (in more than half of the blogs) concepts placed into
categories included Interaction, Negative Self-Worth, Mind and Body Disturbances, Pictures,
and Eating Disorder. Other less repetitive themes mentioned six to eight times were Suicide,
Diet, Exercise, Stats, and Recovery. Additional themes mentioned less than six times were
Trigger Warnings, Positivity, Sexuality, Family, Drugs, Relationships, and Art.
Interaction
All fifteen analyzed blogs discussed interaction with other blog users. The owner
receives messages from other users and publicly answers each question or comment on their
own blog. Questions and comments received by the owner toggle between negative and
positive. For example, owners are criticized for their blog content such as self-photographs
personal statistics, or their documented eating disordered behaviors. One commenter
messaged the owner telling her she was fat, and the owner did not fight back but accepted and
acknowledged the criticism, “Anonymous asked: You’re ffffaaaatttt” [sic]“I kknnooowww”
(Owner’s Response).
Owners also receive support and compassion from users who appear to
metaphorically reach out a helping hand. In regards to the above comment, another Tumblr
user messaged the owner to defend her from such harsh name-calling, “run-like-the-
wolf asked: First of all that anon can go boil their head in oil. Secondly you are not an idiot,
you CAN recover, right now you are having a set back and that is ok, it is, as long as you get
back up and keep fighting which I KNOW you can. Never listen to the words of someone
6 The Qualitative Report 2014
who is too cowardly to even show their face. Stay strong beautiful girl <3” “Thank you so SO
much sweetie xxxx” (Owner’s response).
The responses to the questions and comments vary among individual blog owners.
Owners may answer negatively or positively. Negative answers can either be directed
towards the commentator or towards the owner who received the comments or question. In
self-response, the owner emphasized self-criticism and negative self-worth.
Other examples of interaction included inquiries about the owner’s statistics, the
owner writing about interaction outside of Tumblr site, for example with friends, and the
owner blatantly stating that she does not support or encourage eating disorders or other forms
of harmful behavior, “I DO NOT ENCOURAGE OR PROMOTE SELF HARM IN ANY
WAY SHAPE OR FORM. THAT IS JUST HOW I DEAL WITH THINGS. I WILL BE
THERE TO HELP ANYONE WHO NEEDS IT.” Some owners also post hotlines for
harmful behavior.
Negative Self-Worth
Fifteen out of the fifteen blogs displayed content regarding negative self-worth. Blog
owners often referred to themselves as a disappointment as well as fat, disgusting, stupid,
ugly, pathetic, worthless, weak, hideous, a failure, damaged, ruined, fragile, helpless, flawed,
etc. One blog posted a quote which read, “You don’t deserve to eat. You really don’t. Look
at you. You’re fat. Your bones are being crushed under all of this fat. You did this to
yourself. Now you have to pay for it. STARVE.” Self-hatred was apparent and self-harm
was overwhelming documented on thirteen of the fifteen blogs. Derogatory words and
phrases were also used in self-description. These phrases supported the concept of negative
self-worth. Some example phrases including “fucked up,” “imperfect,” and “shitty person”
appeared on the blogs. These statements were self-directed statements but still have an
impact on readers of the blog page.
Mind and Body Disturbances
Mind and body disturbances are negative physical or mental side-effects self-reported
to be related to disordered eating behaviors. For example, shaking and dizziness are physical
consequences of the blog owner bingeing and purging. Issues such as anxiety, depression,
insomnia, borderline personality disorder, body dysmorphic disorder, hallucinations, and
stress were consistently reported among the blogs, “I suffer from depression & self harm. I
have anorexic tendencies, but I can’t necessarily say I have anorexia due to the fact that I
have not been diagnosed. I have anxiety disorder & panic attacks & I’m prone to migraines.”
Nine out of fifteen bloggers wrote about their perceived reflection in the mirror. They
suggested negative and distorted perceptions of their mirror reflection. Unhappiness,
numbness, loneliness, anger, mood fluctuation, distress, and panic are other examples of
concepts that appeared under this category.
Pictures
Each analyzed blog displayed several pictures ranging in content. Photo content
included knee- high socks, cats, tea, books, and scenery. More importantly however, were
the photos portraying women’s bodies. Visibility of bones was emphasized among the
majority of the blogs. Hip bones, rib bones, and back bones were continuously highlighted as
well as extremely thin arms and legs paying particular attention to a “thigh-gap.” Five of the
fifteen blogs displayed photos of women crying or reflecting a saddened facial expression.
Jacqueline Gies and Sara Martino 7
Owners reblogged photos of thin females but occasionally posted pictures of their own face
and body. Fit and in-shape females bodies were also represented on three of the chosen blog
sites, accentuating toned arms and legs and abdominal muscles.
Self-harm was also a concept of the pictures. Nine blog owners had sites containing
pictures of cut body parts such as the arms, legs, and shoulders. Women engaging in the act
of purging were also included within this theme. Four blogs depicted purging women at the
time of the study. It is worth mentioning that two blogs had pictures of Barbie included in
their content.
Eating Disorders
All fifteen blog owners referenced or described their eating disorder in some context.
Owners often documented their form of disordered eating, for example anorexia or bulimia,
“I’ve been diagnosed with depression and bulimia.” Owners wrote about the behaviors that
consequently came with the disorder. Five blog owners described the control of the eating
disorder over the owners’ life:
I am convinced I am no longer my own person. I am an amalgamation of
many different beings, my actions are not my own, my thoughts, even less so,
it seems. There is this miserable creature that eats at my insides, and brings
with it a suffocating black that extinguishes any good thing. And this anxious
creature that claws at my skull, that creates such unbearable agitation and
incapacitates me, renders me speechless, unable to concentrate, wipes my
mind of all thoughts but that which causes me distress. And this hateful
creature that hisses at me to eat less, be less, do more, work harder, push
harder, lose weight, punish myself. And this overwhelming feeling of
hopelessness and despair that has scratched it’s way under my skin and
poisoned my blood. I feel as though I am constantly having to placate one
creature or another, or all at once, and it is frightening, and exhausting. I’ve
honestly really just had enough.
Five owners claimed that they were not skinny enough or they were too fat to have
an eating disorder and five owners openly compared their bodies to other females’ bodies.
Owners also mentioned their fears as well as their desires, or lack of desires. For instance,
one blog stated that the owner has no desire to eat at all. This same owner also had the desire
for perfection. The desire to be skinny, to be underweight, and to look sick was apparent
throughout the blogs. A fear of food was also obvious through the owners’ self -written
comments. Bloggers write about eating being weakness and control being powerful. One
owner wrote that she felt pleasure from having an empty stomach. Pride coincides with
minimal to no consumption. There is also a fear of numeric calories and a fear of becoming
fat. Regret immediately follows consumption. Owners also document their binge and purge
episodes as well as restricting and fasting patterns for public viewing.
Owners openly discuss their thoughts and behaviors relative to the eating disorder
they suffer from. They wrote about their triggers, morbid thoughts, the amount of time they
have been suffering from the disorder, side effects such as cold sweats and nightmares, the
“high” that follows a purge episode, and the guilt associated with eating. Other examples of
thoughts and behaviors documented on the blogs include a fascination with weight and
visibility of bones, the exhaustion the eating disorder brings to the victim, the desire to purge
feelings away, fainting spells, mood fluctuation, chewing gum to avoid eating, and the
amount of weight that the owner wants to lose.
8 The Qualitative Report 2014
Suicide
Suicide was referenced on thirteen blogs. Users want to give up their efforts and
admitted to wanting to kill themselves, “My note. Sometimes I want to die. Okay, it’s more
often than sometimes. I really want to die almost all the time. I say I won’t kill myself
because I know how much it will hurt my family…but isn’t that what I’m doing? I’m
starving myself and torturing my body. It’s a slow, unnoticeable suicide. One day, this can
kill me. I am suicidal in more than just my thoughts and dreams, I’m living my life slowly
killing myself. I’ve tricked myself into thinking that living with this eating is a lesser form of
suicide than simply slitting my wrists. I justify it to myself and make it okay. My family will
still hurt, my boyfriend (if he sticks around) will still hurt, my best friend will still hurt. I will
still be dead, it just won’t be as soon as I wish. I will still cause the same pain to them,
maybe even more. This way, they’ll ask “why didn’t I see her losing so much weight? Why
didn’t I notice? Why didn’t I do something?” If I slit my wrists, they’ll wish they had been
there for me, but if I die to this eating disorder, they’ll wonder how it progressed so far
without their realization of how sick I was. This is not okay. I will still break their hearts. I
still consider this suicide, but for some reason, I’m okay with it. For some reason, I accept it.
This is my suicide note. This is me giving up. I won’t be dead by tonight, not even by
tomorrow, but one day I will be. I’m not currently asking for help. I’m not reaching out,
crying for attention, or looking for support. I’m admitting to everyone, including myself, that
I am far more suicidal than I realized. If I don’t recover, I will die to this. At this moment,
I’m okay with that.”
Suicide warning signs and information about suicide such as hotlines and what it may
be (such as distinguishing cutting behaviors from a suicide attempt of taking pills) were
noted. Two owners wrote that they have actually made unsuccessful suicide attempts. One
owner made a promise to her Tumblr followers that she would not attempt suicide even
though she has a desire to kill herself. Another owner wrote that she would commit suicide
by starvation. Another owner wrote that it is not suicide if she is already dying.
Diet
Eleven blogs reported the owners’ diet choices. The “zero-calorie” diet and the
“ABC” diet were mentioned. One owner wrote that her choice to be vegan was just an
excuse to starve. There were logs of the owners’ daily intake. Skipping meals, inadequate
calorie consumption, gum chewing as a replacement for food, calorie counting, diet coke, and
green tea as a replacement for food were popular among the logs, “for breakfast I had: Whole
Grain sesame seed bagel – 250 with butter (1 tsp) – 30 and laughing cow (2 triangles) – 50
passion orange guava BoastHouse drink (about half a serving) – 85 and a fruit salad with
berries (1 cup) – 70 black coffee on the side with 1 tsp of sugar – 35 for a total of 501 holy
crap but it was all really good and I’m super full and that’s good.” Denial of food and hunger
also occurred. One owner wrote that she had dieted since a very young age.
Exercise
Exercise was mentioned in each blog site, mainly describing it as as a purging tool in
a bingeing-purging cycle. Owners exercise until exhaustion, in the middle of the night to
work off consumed calories, and to lose weight, “624 calories of food, but managed to burn
off 406 riding my bike downtown.” Forms of exercise were also documented including the
“Victoria Secret” workout, dancing, running, swimming, biking, walking, and various
workout videos pulled from the Internet. These behaviors were described in detail, which
Jacqueline Gies and Sara Martino 9
may have a negative impact on the reader of the blog, again demonstrating some “tips” of
eating disorder behavior.
Statistics
Statistics, in particular body statistics, were logged on nine out of fifteen blogs.
Personal records of the owner include height, BMI, body fat percentage, current weight,
highest weight, lowest weight, goal weight, and ultimate goal weight. Previous weights and
measurements of other body parts were also documented. An example of documented
statistics appeared as such, “Stats: Height: 5’4,” Body Fat Percentage: 14.5%, BMI: 18.5,
Current Weight: 107.2lbs, Highest Weight: 127lbs, Lowest Weight: 88lbs, Goal Weight:
100lbs, UW: 96lbs. -Measurements- Bust: 32.5in, Waist (at narrowest point): 24in, Hips (at
widest point): 31in, Thigh (at widest point): 19in, Calf (at widest point): 13in, Bicep: 10in,
Forearm: 8in, Wrist: 6in.” Others important stats kept on some of the blogs were the date of
the last cutting incident and updates on eating disorder recovery and relapse. Continuous
weight tracking was also a concept of the statistics theme.
Recovery
There was mention of recovery on eight of the fifteen blogs. Seven of the blog
owners expressed that recovery was not for them, it was too late to recovery, it was a joke,
and the possibility of recovery was weak and unattainable, “This is impossible; I'm really not
sure that I am capable of recovery; I certainly don't deserve it.” One owner did mention that
she was working towards recovery but there was no evidence of progress. Two owners
related recovery to being fit, strong, and working out on a regular basis.
Other Themes
Themes concerning trigger warnings, positivity, sexuality, family, drugs,
relationships, and art appeared six times or less among the blogs, but are noteworthy
nonetheless. Trigger warnings, positivity, and family were concepts found on six of the
analyzed blogs. Trigger warnings were used as a notification to other Tumblr users that the
owner’s blog displays images and written posts that relate to harmful behavior which could
trigger harmful or disturbing behaviors and thoughts within the viewer, “This is a hell that I
would not wish on my worst enemy. With that being said, some posts may be triggering.
Sorry, I’m sick. You have been warned.” Trigger warnings were in effect for eating
disorders, self-harm, suicide, and depression.
There were some positive concepts expressed on various blogs. Positive concepts
regarded activities that the blog owner enjoys such as web-design, cats, reading, yoga,
meditation, and writing. There was also a reflection of support and compassion on the blogs.
Support was stretched to those who self-harm or are suicidal. There was recognition for the
support that was shown from the Tumblr community towards the blog owner and well as
recognition of the fact that people are allowed to make mistakes. Some blog owners also
showed themselves self-support by posting images, quotes, or entries regarding self-beauty,
the effort to “Just Keep Trying” and to keep holding on, and how to correctly measure self-
worth.
Four blogs openly expressed support and awareness for the gay and lesbian
community. One blog’s sexuality content regarded a harmful sexual history involving
molestation, sexual assault, and rape. Family concepts were negative in context. Of the six
blog owners who wrote about their families, all six owners had a negative outlook towards
10 The Qualitative Report 2014
their families. These negative outlooks were described as coming from their families’
misinterpretations of psychiatric opinion, one or both parents forcing the victim to eat, and
watching the victim causing her to feel uncomfortable and pressured. Parents were also
ignorant to disorder and there was anger directed towards the parents. One owner wrote that
she resents her mother because her mother made her diet at a very young age. She also hates
her father because he is a drug addict and an alcoholic and was very abusive towards the blog
owner.
The use of drugs was documented on three blogs. The drugs involved were ecstasy,
weed, coke, and abuse of sleeping pills. Sleeping pills were used to avoid bingeing and
purging. Some users admitted to love the feeling of getting high, and one user related the
rush from bingeing and purging to the feeling of being high. Relationship content appeared
on three blogs. One blog owner had a desire to be loved by someone who would be
accepting of the person she is. The other two owners had relationship issues. One female
used her relationship to further her disorder by spending time with her boyfriend to distract
herself from eating. The other girl lost her relationship with her boyfriend because he did not
want to take care of her anymore.
Finally, an art theme arose throughout the study. Five blog owners used art to portray
their thoughts and feelings. The art form that appeared during the study was either poetry or
paintings and drawings. Poetry referred to the owner’s lost mind and obsession as well as the
eating disorder. There was one poem about beauty. Paintings and drawings depicted a
expressively sad girl over a toilet, a painting of a skeleton, a drawing of the ideal perfect
body, and a drawing of cut arms.
Discussion
In an age where the Internet is common ground for world-wide human interaction it is
necessary to monitor the activity that is taking place. In the realm of eating disorders, victims
are anonymously sharing their personalized tips, tricks, rituals, thoughts, experiences, and
desires (e.g., Tierney, 2006). Tumblr is an interesting social network because it grants its
users anonymity and personalization to each individual blog page. The users mix interaction
with other Tumblr bloggers and personal posts and pictures of interest on their pages.
Although no two blog users are the same, common themes appeared connecting the
individuals in relation to eating disorders.
Analyzing the blogs using a qualitative approach proved to be advantageous.
Previous research investigating causal factors of eating disorders was found to be related to
concepts in the blogs, such as anxiety, depression, stress, unhappiness, loneliness, and other
emotional turmoil. These concepts are significantly linked to onset and maintenance of the
disorders (Adambegan et al., 2012). Adambegan et al. also mentioned social withdraw as a
behavioral abnormality that plays a role in the disorder spectrum. The externalization of
these disturbances to an online community supports this idea.
The negative self-worth theme was apparent on every blog. Vehement language was
used by the bloggers as a description of self, expressing words such as pathetic, fat, useless,
ugly, hideous, damaged, and disgusting. These were repeatedly employed. Violent behavior
over the Internet exists in an extreme form. In this particular case, violent behavior directed
towards the self is alarming. In some circumstances the Internet is not solely an arena to
harass and humiliate others as Sugarman and Willoughby (2013) pointed out, but a place
where people self-humiliate and self-harass as well.
An interesting theme that emerged was the pictures selected to be displayed on the
blog owners’ pages. Women were shown to have bones protruding through their skin,
specifically in the hip, rib, back and collar bone regions. Thin arms, thin legs, and the “thigh-
Jacqueline Gies and Sara Martino 11
gap,” or having space between the legs right where they meet in the pelvic region, were
highlighted. Women were also crying or saddened. Cuts on different body parts and women
purging existed as well. Wilson et al. concluded that exposure to eating disorder material on
the Internet may negatively impact life and could increase disordered eating behaviors
(2006). The visual display of internalized emotions and desires could increase motivation to
maintain the disorder in order to achieve what is represented in the pictures. This is
dangerous on a large scale because the pictures are passed around from blog to blog. If one
user finds interest on a picture displayed on another user’s blog, they can easily “reblog” the
picture to their own where their followers can see. Tierney warns about such activity stating
that some online interaction may reinforce dysfunctional practices (2006).
Previous studies reinforce the fact that eating disorder content can encourage
disordered behaviors with individuals involved in the online community (Borzekowski et al.,
2010, Jett et al., 2010, Lapinski, 2006, Rouleau & von Ranson, 2011, Tierney, 2006, Wilson
et al., 2006). Similar to Borzekowski et al., this study stresses that researchers, professionals,
and family or friends of an eating disorder victim monitor interactive online communication
to gain a new perspective and insight on information that may not be readily available via
face-to-face interaction.
Although personal blogs and pro-ED websites have different aspects, the current
research supports previous studies wherein online exposure and interaction regarding eating
disorders can be harmful. The study also revealed that there was little treatment discussed in
the blogs; possibly also supporting the notion that these sites are used for maintaining and not
supporting treatment of the disorder. However, this study dissected personal blogs to
discover the themes and concepts behind the reason of why such material can be harmful and
what information can be useful in aiding prevention, treatment, and education. The purpose
of this study was to comprehend what is going on “behind the scenes.” By acknowledging
the negative material presented in this study, society can build upon the effort to decrease the
prevalence of eating disorders and efficiently approach the issues that currently exist.
One limitation of this study to address is that the blogs are continuously being updated
on a day to day basis. This means that the appearance of themes found in this study using the
selected blogs may change minimally or drastically if a similar study was completed using
fifteen different blogs. More research in this area may lead to new concepts and categories
emerging, so continuing this grounded theory process is recommended. Another limitation
to this study is the number of blogs that underwent analysis. Tumblr reports that there are
103.2 million blogs hosted by Tumblr, 44.6 billion posts, and 75.3 million daily posts. This
research is the first known to implement grounded theory to pull themes from the Tumblr
blogging network. As such, other themes and concepts may be in existence that were not
identified in this study. Every other site was chosen for selection in this study up to 15 blogs,
however, that is still a small number of blogs reviewed. Additionally, they were found using
a keyword search and different terms may have allowed other blogs to emerge on that given
day and time.
To assure the resulting content of this study, future studies may analyze a greater
number of blogs to defend the themes and continue the study over a longer period of time to
account for the ongoing blog entries. This will also give the researcher an opportunity to
discover, if any, new themes. Another recommendation for further research is to contact the
blog owners and administer questionnaires to further support the findings. Finally, future
research may include quantitative techniques to determine how individuals with ED view
personal blogs and if those results coincide with the themes that have emerged here. Overall,
this research contributes to the field of eating disorders in that it uncovers another mechanism
being used by females with eating disorders to possible support their continued identity of
disordered eating, similar to findings of “pro-ana” and “pro-mia” websites (Tierney, 2006).
12 The Qualitative Report 2014
This will help to raise awareness of the possible pitfalls of online communication as a
treatment tool. Here are some resources on APA style that you can use to quickly address the
earmarked errors in citation and style. I included some samples of the text that are specific to
your study.
http://www.library.cornell.edu/resrch/citmanage/apa
http://www.apastyle.org/
Undated Web site content, blogs, and data
For content that does not easily fit into categories such as journal papers, books, and
reports, keep in mind the goal of a citation is to give the reader a clear path to the source
material. For electronic and online materials, include stable URL or database name. Include
the author, title, and date published when available. For undated materials, include the date
the resource was accessed.
Blog entry
Arrington, M. (2008, August 5). The viral video guy gets $1 million in funding.
Message posted to http://www.techcrunch.com
Audio-visual media
References to audio-visual media must include the following elements: name and
function of the primary contributors (e.g., producer, director), date, title, the medium in
brackets, location or place of production, and name of the distributor. If the medium is
indicated as part of the retrieval ID, brackets are not needed.
Short quotations
If you are directly quoting from a work, you will need to include the author, year of
publication, and the page number for the reference (preceded by "p."). Introduce the
quotation with a signal phrase that includes the author's last name followed by the date of
publication in parentheses.
According to Jones (1998), "Students often had difficulty using APA style,
especially when it was their first time" (p. 199).
Jones (1998) found "students often had difficulty using APA style" (p. 199);
what implications does this have for teachers?
If the author is not named in a signal phrase, place the author's last name, the year of
publication, and the page number in parentheses after the quotation.
She stated, "Students often had difficulty using APA style" (Jones, 1998, p.
199), but she did not offer an explanation as to why.
Long quotations
Place direct quotations that are 40 words, or longer, in a free-standing block of
Jacqueline Gies and Sara Martino 13
typewritten lines, and omit quotation marks. Start the quotation on a new line, indented 1/2
inch from the left margin, i.e., in the same place you would begin a new paragraph. Type the
entire quotation on the new margin, and indent the first line of any subsequent paragraph
within the quotation 1/2 inch from the new margin. Maintain double-spacing throughout. The
parenthetical citation should come after the closing punctuation mark.
Jones's (1998) study found the following: Students often had difficulty using
APA style, especially when it was their first time citing sources. This
difficulty could be attributed to the fact that many students failed to purchase a
style manual or to ask their teacher for help. (p. 199)
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Author Note
Jacqueline Gies earned her Bachelor of Arts, Psychology from the Richard Stockton
College of New Jersey. She is currently employed with Spring Village at Galloway Assisted
Living and Memory Care as a Customer Service Representative. Her research interests
include eating disorders, holistic health and positive psychology, and gerontology.
Sara Dettinger Martino completed her PhD in counseling psychology at Temple
University in Philadelphia, Pennsylvania, in 2005. She has been a full-time associate
professor at Richard Stockton College since 2005 and is coordinator of the Women, Gender,
and Sexuality Studies minor. Her research interests include several women's issues, such as
indirect aggression, risk factors of early menarche, clinical interventions for self-mutilating
behaviors, and new positive psychology interventions for mental illness. Her clinical
experiences include work in community counseling as well as a state facility. Please send
correspondence to: Sara Martino, Ph.D., LPC, Associate Professor of Psychology, Richard
Stockton College of New Jersey, 101 Vera King Farris Drive, Galloway, NJ 08205; Email:
martinos@stockton.edu
Copyright 2014: Jacqueline Gies, Sara Martino, and Nova Southeastern University.
Jacqueline Gies and Sara Martino 15
Article Citation
Gies, J., & Martino, S. (2014). Uncovering ED: A qualitative analysis of personal blogs
managed by individuals with eating disorders. The Qualitative Report, 19(57), 1-15.
Retrieved from http://www.nova.edu/ssss/QR/QR19/gies57.pdf
