Jessica A. Pater
Brooke Farrington
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Abstract
Digital self-harm encompasses a variety of activities, including the use of social media to facilitate or amplify mental illness-related behaviors. To understand the extent of these behaviors and their impacts, we conducted an in-depth case study with three patients who are in recovery from an eating disorder. We collected survey data, conducted interviews reflecting back to their technology use during their active disease state, and reviewed up to 18 months of their social media data leading up to the start of their initial point of recovery. Through the triangulation of this data, we explore the role of social media and social technologies in relation to their eating disorder. By utilizing this methodology, we were able to provide a contextually rich and nuanced lens for exploring the impacts of digital self-harm on this group of patients. We found that patients acknowledged that the eating disordered content on social media had a negative impact on their health, often contributing to a worsening of the physical manifestations of their disorder. Conversely, while they actively consumed this content, our participants did not produce online content related to eating disordered activities or behaviors. Finally, we discuss the patterns within their social media data and how platform designers and operators could use these findings in the future through design considerations for future platform-based interventions.
- Nazanin Andalibi, Pinar Ozturk, and Andrea Forte. 2017. Sensitive Self-disclosures, Responses, and Social Support on Instagram: The Case of #Depression. In Proceedings of the 2017 ACM Conference on Computer Supported Cooperative Work and Social Computing (CSCW '17). ACM, New York, NY, USA, 1485--1500. https://doi.org/10.1145/2998181.2998243Google Scholar
Digital Library
- Albert Bandura. 1986. Prentice-Hall series in social learning theory. Social foundations of thought and action: A social cognitive theory. Prentice-Hall, Inc, Englewood Cliffs, NJ, USA.Google Scholar
- Pamela Baxter and Susan Jack. 2008. Qualitative Case Study Methodology: Study Design Implementation for Novice Researchers. The Qualitative Report 13, 4 (2008), 544--559. https://nsuworks.nova.edu/tqr/vol13/iss4/2Google Scholar
- Dror Ben-Zeev, Christopher J. Brenner, Mark Begale, Jennifer Duffecy, David C. Mohr, and Kim T. Mueser. 2014. Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophrenia Bulletin 40, 6 (2014), 1244--1253. https://doi.org/10.1093/schbul/sbu033Google ScholarCross Ref
- Shengjie Bi, Tao Wang, Ellen Davenport, Ronald Peterson, Ryan Halter, Jacob Sorber, and David Kotz. 2017. Toward a Wearable Sensor for Eating Detection. In Proceedings of the 2017 Workshop on Wearable Systems and Applications (WearSys '17). ACM, New York, NY, USA, 17--22. https://doi.org/10.1145/3089351.3089355Google ScholarDigital Library
- Michael L. Birnbaum, Sindhu Kiranmai Ernala, Asra F. Rizvi, Munmun De Choudhury, and John M. Kane. 2017. A Collaborative Approach to Identifying Social Media Markers of Schizophrenia by Employing Machine Learning and Clinical Appraisals. JMIR 19, 8 (2017), e289. https://doi.org/10.2196/jmir.7956Google Scholar
- US Census Bureau. 2018. QuickFacts, Fort Wayne, IN. https://www.census.gov/quickfacts/fortwaynecityindianaGoogle Scholar
- Stevie Chancellor, Yannis Kalantidis, Jessica A. Pater, Munmun De Choudhury, and David A. Shamma. 2017. Multimodal Classification of Moderated Online Pro-Eating Disorder Content. In Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems (CHI '17). ACM, New York, NY, USA, 3213--3226. https://doi.org/10.1145/3025453.3025985Google ScholarDigital Library
- Stevie Chancellor, Zhiyuan Lin, Erica L. Goodman, Stephanie Zerwas, and Munmun De Choudhury. 2016. Quantifying and Predicting Mental Illness Severity in Online Pro-Eating Disorder Communities. In Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing (CSCW '16). ACM, New York, NY, USA, 1171--1184. https://doi.org/10.1145/2818048.2819973Google ScholarDigital Library
- Stevie Chancellor, Jessica A. Pater, Trustin Clear, Eric Gilbert, and Munmun De Choudhury. 2016. #Thyghgapp: Instagram Content Moderation and Lexical Variation in Pro-Eating Disorder Communities. In Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing (CSCW '16). ACM, New York, NY, USA, 1201--1213. https://doi.org/10.1145/2818048.2819963Google ScholarDigital Library
- Munmun De Choudhury. 2015. Anorexia on Tumblr: A Characterization Study. In Proceedings of the 5th International Conference on Digital Health 2015 (DH '15). ACM, New York, NY, USA, 43--50. https://doi.org/10.1145/2750511.2750515Google ScholarDigital Library
- Munmun De Choudhury, Scott Counts, Eric J. Horvitz, and Aaron Hoff. 2014. Characterizing and Predicting Postpartum Depression from Shared Facebook Data. In Proceedings of the 17th ACM Conference on Computer Supported Cooperative Work & Social Computing (CSCW '14). ACM, New York, NY, USA, 626--638. https://doi.org/10.1145/2531602.2531675Google ScholarDigital Library
- Munmun De Choudhury and Sushovan De. 2014. Mental health discourse on reddit: Self-disclosure, social support, and anonymity. In Proceedings of the Eighth International AAAI Conference on Weblogs and Social Media (ICWSM '14). AAAI, 71--80. https://www.aaai.org/ocs/index.php/ICWSM/ICWSM14/paper/viewPDFInterstitial/8075/8107Google Scholar
- Munmun De Choudhury, Michael Gamon, Scott Counts, and Eric Horvitz. 2013. Predicting depression via social media. In Proceedings of the Seventh International AAAI Conference on Weblogs and Social Media (ICWSM '13). AAAI, 128--137. https://www.aaai.org/ocs/index.php/ICWSM/ICWSM13/paper/viewPDFInterstitial/6124/6351Google Scholar
- Munmun De Choudhury, Emre Kiciman, Mark Dredze, Glen Coppersmith, and Mirnal Kumar. 2016. Discovering Shifts to Suicidal Ideation from Mental Health Content in Social Media. In Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems (CHI '16). ACM, New York, NY, USA, 2098--2110. https://doi.org/10.1145/2858036.2858207Google ScholarDigital Library
- danah boyd. 2010. Digital self-harm and other acts of self-harassment. www.zephoria.orgGoogle Scholar
- Tara Donker, Katherine Petrie, Judy Proudfoot, Janine Clarke, Mary-Rose Birch, and Helen Christensen. 2013. Smartphones for Smarter Delivery of Mental Health Programs: A Systematic Review. JMIR 15, 11 (2013), e247. https://doi.org/10.1145/2957276.299628Google Scholar
- Elizbaeth V. Eikey. 2016. Privacy and Weight Loss Apps: A First Look at How Women with Eating Disorders Use Social Features. In Proceedings of the 19th International Conference on Supporting Group Work (GROUP '16). ACM, New York, NY, USA, 413--415. https://doi.org/10.1145/2957276.2996282Google ScholarDigital Library
- Elizbaeth V. Eikey. 2016. The Use of Weight Loss Apps by Women with Eating Disorders. In Proceedings of the 2016 ACM SIGMIS Conference on Computers and People Research (SIGMIS-CPR '16). ACM, New York, NY, USA, 3--4. https://doi.org/10.1145/2890602.2906187Google ScholarDigital Library
- Elizabeth V. Eikey and Madhu C. Reddy. 2017. "It's Definitely Been a Journey": A Qualitative Study on How Women with Eating Disorders UseWeight Loss Apps. In Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems (CHI '17). ACM, New York, NY, USA, 642--654. https://doi.org/10.1145/3025453.3025591Google Scholar
- Kathleen M. Eisenhardt. 1989. Building Theories from Case Study Research. Academy Management Review 14, 4 (1989), 532--550. https://doi.org/10.5465/amr.1989.4308385Google ScholarCross Ref
- Manfred F. Fichter, Norbert Quadflieg, and Susanne Hedlund. 2006. Twelve year course and outcome predictors of anorexia nervosa. International Journal of Eating Disorders 39, 2 (2006), 87--100. https://doi.org/10.1002/eat.20215Google ScholarCross Ref
- SAMHSA-HRSA Center for Integrated Health Solutions. https://www.integration.samhsa.gov/clinicalpractice/screening-toolsdrugs. Screening Tools.Google Scholar
- George Gerbner, Larry Gross, Michael Morgan, Nancy Signorielli, and James Shanahan. 2002. Growing up with television: Cultivation processes. In LEA's communication series. Media effects: Advances in theory and research, J. Bryant and D. Zillmann (Eds.). Lawrence Erlbaum Associates Publishers, Mahwah, NJ USA, Chapter 3, 43--67.Google Scholar
- Stefanie T. Greenberg and Eva G. Schoen. 2008. Males and eating disorders: Gender-based therapy for eating disorder recovery. Professional Psychology: Research and Practice 39, 4 (2008), 464--471. https://doi.org/10.1037/0735--7028.39.4.464Google ScholarCross Ref
- Sharath Chandra Guntuku, David B. Yaden, Margaret L. Kern, Lyle H. Ungar, and Johannes C. Eichstaedt. 2017. Detecting depression and mental illness on social media: an integrative review. Current Opinion in Behavioral Sciences 18 (2017), 43--49. https://doi.org/10.1016/j.cobeha.2017.07.005Google ScholarCross Ref
- Jon Hammermeister, Barbara Brock, David Winterstein, and Randy Page. 2005. Life without TV? cultivation theory and psychosocial health characteristics of television-free individuals and their television-viewing counterparts. Health Communication 17, 3 (2005), 253--264. https://doi.org/10.1207/s15327027hc1703_3Google ScholarCross Ref
- Ron D. Hays, Cathy Donald Sherbourne, and Rebecca M. Mazel. 1993. The rand 36-item health survey 1.0. Health economics 2, 3 (1993), 217--227. https://doi.org/10.1002/hec.4730020305Google Scholar
- QPR Institute. 2018. Question, Persuade, Refer Training. https://qprinstitute.comGoogle Scholar
- John E.Ware Jr. and Cathy Donald Sherbourne. 1992. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical care 30, 6 (1992), 473--483.Google ScholarCross Ref
- Sylvia Kauer, Sophie Reid, Alenxander Crooke, Angela Khor, Stephen John Hearps, Anthony Jormand Lena Sanci, and George Patton. 2012. Self-monitoring Using Mobile Phones in the Early Stages of Adolescent Depression: Randomized Controlled Trial. JMIR 14, 3 (2012), e67. https://doi.org/10.2196/jmir.1858Google Scholar
- Kurt Kroenke, Robert L. Spitzer, Janet B.W. Williams, and Bernd Lowe. 2009. An ultra-brief screening scale for anxiety and depression: the PHQ--4. Psychosomatics 50, 6 (2009), 613--621. https://doi.org/10.1016/S0033--3182(09)70864--3Google Scholar
- Eric Kuhn, Nitya Kanuri, Julia E Hoffman, Donn W. Garvert, Josef I. Ruzek, and C. Barr Taylor. 2017. A randomized controlled trial of a smartphone app for post-traumatic stress disorder symptoms. Journal of Consulting and Clinical Psychology 85, 3 (2017), 267--273.Google ScholarCross Ref
- Cliff Lampe, Jessica Vitak, Rebecca Gray, and Nicole Ellison. 2012. Perceptions of Facebook's Value As an Information Source. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI '12). ACM, New York, NY, USA, 3195--3204. https://doi.org/10.1145/2207676.2208739Google ScholarDigital Library
- LivingWorks. 2018. Applied Suicide Intervention Skills Training (ASIST). https://www.livingworks.net/asistGoogle Scholar
- Michael Morgan, James Shanahan, and Nancy Signorielli. 2016. Cultivation Theory. In The International Encyclopedia of Communication Theory and Philosophy. Wiley Online Library. https://doi.org/10.1002/9781118766804.wbiect015Google Scholar
- Rebecca Murphy, Suzanne Straebler, Zafra Cooper, and Christopher Fairburn. 2010. Cognitive Behavioral Therapy for Eating Disorders. Psychiatric Clinics 33, 3 (2010), 611--627. https://doi.org/10.1016/j.psc.2010.04.004Google Scholar
- US Bureau of Labor Statistics. 2019. Midwest Information Office: Fort Wayne. https://www.bls.gov/regions/midwest/in_fortwayne_msa.htmlGoogle Scholar
- Justin W. Patchin and Sameer Hinduja. 2017. Digital self-harm among adolescents. Journal of Adolescent Health 61, 6 (2017), 761--766. https://doi.org/10.1016/j.jadohealth.2017.06.012Google ScholarCross Ref
- Jessica A. Pater, Oliver L. Haimson, Nazanin Andalibi, and Elizabeth D. Mynatt. 2016. "Hunger Hurts but Starving Works": Characterizing the Presentation of Eating Disorders Online. In Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing (CSCW '16). ACM, New York, NY, USA, 1185--1200. https://doi.org/10.1145/2818048.2820030Google Scholar
- Jessica A. Pater, Andrew D. Miller, and Elizabeth D. Mynatt. 2015. This Digital Life: A Neighborhood-Based Study of Adolescents' Lives Online. In Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems (CHI '15). ACM, New York, NY, USA, 2305--2314. https://doi.org/10.1145/2702123.2702534Google Scholar
- Jessica A. Pater and Elizabeth D. Mynatt. 2017. Defining Digital Self-Harm. In Proceedings of the 2017 ACM Conference on Computer Supported Cooperative Work and Social Computing (CSCW '17). ACM, New York, NY, USA, 1501--1513. https://doi.org/10.1145/2998181.2998224Google Scholar
- Jessica A. Pater, Lauren Reining, Andrew D. Miller, Tammy Toscos, and Elizabeth D. Mynatt. 2019. "Notjustgirls": exploring male-related eating disordered content online. In Proceedings of the 37th Annual ACM Conference on Human Factors in Computing Systems (CHI '19). ACM, New York, NY, USA, 1--13. https://doi.org/10.1145/3290605.3300881Google Scholar
- Ted Pedersen. 2015. Screening Twitter users for depression and PTSD with lexical decision lists. In Proceedings of the 2nd workshop on computational linguistics and clinical psychology: from linguistic signal to clinical reality (ClPsych '15). NAACL, 46--53. https://www.aclweb.org/anthology/W15--1206Google ScholarCross Ref
- James W. Pennebaker, Ryan L. Boyd, Kayla Jordan, and Kate Blackburn. 2015. The Development and Psychometric Properties of LIWC2015. http://hdl.handle.net/2152/31333Google Scholar
- Sophie C. Reid, Sylvia D. Kauer, Stephen J.C. Hearps, Alexander H.D. Crooke, Angela S. Khor, Lena A. Sanci, and George C. Patton. 2011. A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial. BMC Family Practice 12 (2011), 131. https://doi.org/10.1186/ 1471--2296--12--131Google ScholarCross Ref
- Philip Resnik, William Armstrong, Leonardo Claudino, Thang Nguyen, Viet-An Nguyen, and Jordan Boyd-Garner. 2015. Beyond LDA: exploring supervised topic modeling for depression-related language in Twitter. In Proceedings of the 2nd Workshop on Computational Linguistics and Clinical Psychology: From Linguistic Signal to Clinical Reality (ClPsych '15). NAACL, 99--107. https://www.aclweb.org/anthology/W15--1212Google ScholarCross Ref
- Saima Salim. 2019. How much time do you spend on social media? https://www.digitalinformationworld.com/2019/ 01/how-much-time-do-people-spend-social-media-infographic.htmlGoogle Scholar
- Charles Schell. 1992. The Value of the Case Study as a Research Strategy. Manchester Business School 2 (1992). http://www.psyking.net/HTMLobj-3844/Value_of_Case_Study_as_a_Research_Strategy.pdfGoogle Scholar
- Judy Hanwen Shen and Frank Rudzicz. 2017. Detecting anxiety through Reddit. In Proceedings of the Fourth Workshop on Computational Linguistics and Clinical Psychology -- From Linguistic Signal to Clinical Reality (ClPsych '17). NAACL, 55--65. https://www.aclweb.org/anthology/W17--3107Google ScholarCross Ref
- Mayo Clinic Staff. [n. d.]. Cognitive behavioral therapy. https://www.mayoclinic.org/tests-procedures/ cognitive-behavioral-therapy/about/pac-20384610Google Scholar
- Eric Stice, Carolyn Black Becker, and Sonja Yokum. 2013. Eating disorder prevention: Current evidence base and future directions. International Journal of Eating Disorders 46, 5 (2013), 478--485. https://doi.org/10.1002/eat.22105Google ScholarCross Ref
- Andrada Tomoaia-Cotisel, Debra L. Scammon, Norman J. Waitzman, Peter F. Cronholm, Jacqueline R. Halladay, David L. Driscoll, Leif I. Solberg, Clarissa Hsu, Ming Tai-Seale, Vanessa Hiratsuka, Sarah C. Shih, Michael D. Fetters, Christopher G. Wise, Jeffrey A. Alexander, Diane Hauser, Carmit K. McMullen, Sarah Hudson Scholle, Manasi A. Tirodkar, Laura Schmidt, Katrina E. Donahue, Michael L. Parchman, and Kurt C. Strange. 2013. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change. The Annals of Family Medicine 11, Suppl 1 (2013), S115--S123. https://doi.org/10.1370/afm.1549Google ScholarCross Ref
- Janet Treasure and Gerald Russell. 2011. The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. British Journal of Psychiatry 199, 1 (2011), 5--7. https://doi.org/10.1192/bjp.bp.110.087585Google ScholarCross Ref
- Tao Wang, Markus Brede, Antonella Ianni, and Emmanouil Mentzakis. 2017. Detecting and Characterizing Eating- Disorder Communities on Social Media. In Proceedings of the Tenth ACM International Conference on Web Search and Data Mining. Cambridge, United Kingdom, 91--100. https://doi.org/10.1145/3018661.3018706Google ScholarDigital Library
- Dejin Zhao and Mary Beth Rosson. 2009. How and Why People Twitter: The Role That Micro-blogging Plays in Informal Communication at Work. In Proceedings of the ACM 2009 International Conference on Supporting Group Work (GROUP '09). ACM, New York, NY, USA, 243--252. https://doi.org/10.1145/1531674.1531710Google ScholarDigital Library
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- Exploring Indicators of Digital Self-Harm with Eating Disorder Patients: A Case Study
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