Smartphone and Highly Visual Social Media Use Following Acute Treatment for Anorexia Nervosa: Associations With Eating Disorder Severity and Clinical Impairment

OBJECTIVE: Anorexia nervosa (AN) has high relapse risk following acute treatment. Though highly visual social media (HVSM; e.g., Instagram, TikTok) use is associated with higher eating disorder (ED) psychopathology, little research has examined HVSM use during this vulnerable period. This study characterized digital engagement of women recovering from AN and investigated associations between digital engagement and ED psychopathology. METHOD: Participants were N = 90 cisgender women discharged from acute AN treatment within the past 2 months, recruited for a pilot trial evaluating a digital relapse-prevention tool. Baseline surveys assessed smartphone and HVSM use, content-specific engagement, and ED psychopathology (Eating Disorder Examination-Questionnaire; Clinical Impairment Assessment). Spearman correlations and multivariable regression models were used to evaluate relationships between these variables. RESULTS: Instagram was the most used platform (93.3%), followed by Facebook, YouTube, Snapchat, and TikTok. Controlling for covariates, HVSM use was significantly associated with ED severity (b = 0.441, 95% CI [0.108, 0.774]) and clinical impairment (b = 3.443, 95% CI [0.602, 6.285]). Viewing and posting ED content on HVSM were each associated with greater ED severity; viewing ED content was additionally associated with clinical impairment. Engagement with ED recovery content was not associated with ED psychopathology and did not attenuate associations between HVSM use and ED psychopathology. DISCUSSION: HVSM use and ED content engagement were associated with elevated ED psychopathology in women recently discharged from AN treatment. Descriptive patterns suggest algorithmic delivery of ED content through greater reported exposure than intentional following. Clinicians may consider assessing and planning HVSM behaviors during treatment and the post-acute recovery period.