Navigating an Instagram Community for Eating Disorder Recovery: A Qualitative Study of Users' Motivation and Confidence to Change

Navigating an Instagram Community for Eating Disorder Recovery: A Qualitative Study of Users' Motivation and Confidence to Change | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Navigating an Instagram Community for Eating Disorder Recovery: A Qualitative Study of Users' Motivation and Confidence to Change Gaia Albano, Arianna Teti, Salvatore Gullo, Gianluca Lo Coco This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6956741/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Nov, 2025 Read the published version in BMC Psychiatry → Version 1 posted 13 You are reading this latest preprint version Abstract Background: Treatment engagement and motivation to change remain significant challenges that impact treatment delivery in people with eating disorders. Feelings of shame, stigma, ambivalence and lack of motivation are prominent barriers affecting their engagement with treatment. There is recent evidence that using online recovery communities is beneficial in reaching individuals who do not have access to traditional services. The present study has been designed to investigate the perceived significance and level of confidence regarding change exhibited by individuals suffering from an eating disorder who are active participants in a recovery Instagram community. Methods: A mixed methods study surveyed 205 women (mean age = 23.14 years) from an Instragram recovery community. Thematic qualitative analysis was used to evaluate themes reported in response to open-ended questions about participants’ meaning and confidence to change. Results: Participants reported higher scores for motivation to change than for ability to change. Seven themes were interpreted from the qualitative data (i.e. Emotional Needs, Management illness factors, External Motivation, Negative Sel-beliefs, Internal and External Resources, and Characteristics of eating disorders). Conclusions: The results of this study highlight that although participants report the importance of change, there are some concerns about their ability to change, related to their negative self-beliefs and ambivalence about change. The findings also suggest that Instragram recovery communities are promising platforms for improving help-seeking among users with eating disorders. eating disorders motivation to change thematic analysis help-seeking ability to change social media Instagram 1. Background Eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), are complex psychiatric conditions characterized by severe disturbances in eating behaviors, thoughts, and emotions [ 1 ]. These disorders are associated with significant physical complications, psychological suffering, and impaired social functioning [ 2 , 3 ]. Evidence-based clinical guidelines agree that patients with EDs should be treated with psychological therapies [ 4 ] such as cognitive behavioral therapy, family therapy, or more structured specialised treatments such as Maudsley model of anorexia treatment [ 5 , 6 ]. Among evidence-based psychological treatments, enhanced cognitive behavioral therapy (CBT-E) has demonstrated substantial effectiveness, particularly for individuals with BN and BED [ 5 ]. Recent studies report that approximately 65% of patients undergoing CBT-E achieve sustained full remission [ 7 , 8 ]. Nevertheless, treatment engagement and motivation to change remain significant challenges that can significantly impact treatment outcomes [ 9 ], especially in individuals with AN who often experience marked ambivalence toward recovery [ 10 , 11 ]. Motivation to change has been recognized as a crucial predictor of treatment adherence and outcome [ 12 , 13 , 14 ]. Individuals may simultaneously desire recovery and adhere to their disorder, which may provide perceived benefits such as control, emotional regulation, or social validation through weight loss [ 11 ]. Ambivalence is often sustained by cognitive and personality traits such as perfectionism, obsessive-compulsiveness, and rigid thinking [ 15 ], as well as negatively reinforcing behaviors like dietary restriction or binge-purge cycles [ 16 ]. These processes can be conceptualized through theoretical frameworks such as the Transtheoretical Model of Change [ 17 , 18 ] and the Cognitive-Interpersonal Maintenance Model [ 19 ], which underscore the role of individual and relational dynamics in the persistence of EDs and the need for tailored interventions. The importance of confidence to change (i.e. the expectation people have about their ability to make changes) has also been highlighted as a prognostic factor in ED [ 20 ] given that individuals with high levels of confidence are more likely to persevere in challenging situations such as relapses [ 21 ]. In light of these challenges, growing research attention has been directed toward motivational interventions, such as Motivational Interviewing (MI) and Motivational Enhancement Therapy (MET). A recent systematic review and meta-analysis by Linardon et al. [ 22 ] showed that these interventions can significantly improve readiness to change and contribute to improvements in both ED psychopathology and body mass index. Moreover, Denison-Day et al. [ 23 ] conducted a systematic review assessing the effectiveness of clinical interventions explicitly aimed at increasing motivation among ED patients. While motivational levels tended to improve across all treatment modalities, the review highlighted that motivational interventions were particularly effective compared to low-intensity treatments, although their added value over standard therapies remains uncertain. Despite the clinical relevance of motivational work, a substantial proportion of individuals with EDs do not engage with formal treatment services [ 24 ]. Barriers such as stigma, geographical limitations, financial obstacles, and a lack of specialized services contribute to this treatment gap [ 25 , 26 , 27 ]. Patients reported that shame, stigma and guilt as well as ambivalence and lack of motivation were the most prominent barriers affecting their engagement with treatment [ 28 ]. It is worth noting that people with subthreshold or atypical ED symptoms may have limited insight into their condition and poor motivation to change, with a high risk of chronicity and poorer long-term outcomes. In recent years, online communities for ED recovery have emerged as a prominent platform for individuals with EDs to seek information and support related to their struggles and recovery. Although the negative influence of social media for development of disordered eating behaviors [ 29 , 30 ] through the exposure to online proEDs contents [ 31 , 32 ], the role of online recovery communities which are present in social media such as Instagram or TiKTok has been recently examined [ 33 , 34 ]. Research has suggested that these pro-recovery platforms can offer positive support for people with ED as they provide safe spaces for discussion and peer support [ 35 , 36 , 37 ]. More specifically, it was suggested that the use of online recovery communities could be beneficial in reaching individuals with atypical disordered eating or subthreshold symptoms who do not have access to traditional services or are not ready to seek professional help [ 33 ]. To date, it remains unclear which individuals with disordered eating turn to online pro-recovery communities rather than receiving ED treatment, and what their motivations for change might be. Given the importance of stages of change and confidence in improving ED symptoms [ 20 , 9 ], the current study aims to explore users' perceived importance and confidence to change from an ED recovery Instagram (IG) community using a qualitative approach. Understanding community users' stages of change and treatment-seeking attitudes is essential for designing tailored and accessible interventions [ 14 ] and informing strategies for personalized and accessible digital interventions that promote engagement and recovery within online communities [ 35 , 36 ]. 2. Methods Participants and Procedures Participants were recruited from the Italian #How can we help you?” IG community in the first six months after going live. All individuals who contacted the Instagram page to inquire about treatment options for eating disorders were invited to participate in the study via a link to an online questionnaire. Participants were included in the study if they met the following inclusion criteria: (a) being older than 18 years, (b) following the #How Can We Help You? Instagram page, (c) having contacted the page to inquire about eating disorders treatment options. During the recruitment phase of the study, 378 individuals contacted the Instagram page to request information about possible treatment for eating disorders, of whom 54.23% agreed to participate in the study and completed the questionnaire. The final study sample consisted of 205 women (mean age = 23.14 ± 5.85 years). All procedures contributing to this work complied with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All procedures involving human subjects/patients were approved by the local Ethics Committee (masked for review). Written informed consent was obtained from all participants. #How Can We Help You? "#How Can We Help You?: An Instagram-Based Online Self-Help for Eating Disorders," is a ED recovery Instagram community [ 38 ] that aims to provide digital support to individuals struggling within EDs. Various components of support are used, such as psychoeducational posts, interactive stories, and Q&A chat sessions which are designed to actively engage participants and provide practical information and emotional support. Content is curated by mental health professionals, and integrates evidence-based strategies such as emotion regulation, coping mechanisms, and mindfulness techniques. Moreover, the project provides IG directs delivered by content creators – individuals with a significant online presence who have lived experience of eating disorders. As well as helping to spread educational and supportive messages through their profiles, these content creators engage directly with users through published interviews on Instagram (Direct), facilitated by our clinical research team. Scientific content related to eating disorders is published weekly in the form of posts, stories or reels and relates to three macro areas: 1) positive thinking, 2) change as an opportunity, which promotes the importance of change (motivation), and 3) the maintenance factors of an ED. Measures Users were invited to complete an online assessment that included a sociodemographic survey and self-report measures. The online survey consisted of the following questionnaires: Demographic and clinical survey , to collect information on age, geographical area, years of education, employment and social status, self-diagnosis of EDs, duration of illness, time of onset of illness, self-reported body mass index (BMI). The Eating Disorder Examination Questionnaire [EDE-Q; 39, 40] is a 28-item self-report questionnaire to assess attitudes and behaviors associated with eating disorders. All items are rated on a 0–6 Likert scale (with higher scores reflecting greater severity). The measure comprises a Global scale and four subscales (Restraint, Eating Concern, Weight Concern, and Shape Concern), with higher scores indicate higher symptomatology. In the present study, the internal consistency of all subscales and of the score good (ω ranges: .767-.881). The Depression, Anxiety and Stress Scale [DASS-21; 41, 42] is a 21-item self-report measure of patients’ psychological distress over the past 7 days. Items are scored on a four-point Likert scale. It includes three subscales (i.e., anxiety, depression, and stress). In the present study, the internal consistency of all subscales and of the score were good (ω ranges: .895-.922). The Body Appreciation Scale [BAS-2; 43, 44] is a 12-item self-report measure that assess body appreciation. All items are scored on a 5-point Likert scale; higher scores reflect higher body appreciation. In this study, the internal consistency was excellent (ω = .934). Importance and confidence in own ability to change were assessed using two ad hoc Likert-type items, scored from 1 (“not important at all” / “not confident at all”) to 10 (“extremely important” / “extremely confident in my ability to change”). Higher scores suggest greater motivation and ability to change. In addition, the perceived importance and ability for change were also investigated through two open-ended questions, to which participants were asked to respond in as much detail and as comprehensively as possible. The two open-ended questions were: 1) “What are the motivations, needs, and wishes that lead you to change?” and 2) “How much do you feel that you can change? What are your reasons for indicating this score?”. These items have already been used in several RCT studies investigating motivation levels in eating disorders [ 16 , 23 ]. Data Analysis Data from the questionnaires were analysed using descriptive statistics to explore the characteristics of the sample. Qualitative data resulted from the users’ responses to the two open-ended questions were analysed using inductive data-driven thematic analysis [ 45 ] with a realistic approach to allow a more direct focus on the users’ perspectives. The use of an inductive approach was driven by the exploratory nature of the study. The analysis was carried out by two clinical psychologists experienced in thematic analysis and EDs (G.A. & A.T.) using the following procedure. Users' responses were first grouped into two main categories, each corresponding to one of the open-ended questions (i.e. motivation to change and ability to change). In addition, a thematic analysis of the responses to the motivation question was conducted (i.e., "What are the motivations, needs, and wishes that lead you to change?"). This analysis was conducted across the entire sample, thus forming the first cluster of the analysis. Thematic analysis was also employed to code participants' responses to the second open-ended question, the purpose of which was to explore the motivations behind participants' confidence in their ability to recover from ED ("How much do you feel that you can change?"). Participants' responses were initially divided into two groups: the 'high ability to change group' (composed of individuals who rated their ability to change as ≥ 5 on the 10-point Likert scale) and the 'low ability to change group' (composed of individuals who rated their ability to change as less than 5). The two aforementioned groups constituted the second and third clusters, respectively. Subsequent to this procedure, the responses within the three resulting clusters were analysed according to the thematic analysis procedure. First, the psychologists immersed themselves in the data, reading and re-reading users’ responses and using notes to capture emerging insights. Next, the text was divided into units of meaning, identified as the smallest parts that convey a single theme. Each segment was then given a code that reflected its core meaning while remaining faithful to the participants' own expressions. The codes were then compared and organized into clusters, based on their similarities and contrasts, which form our subcategories. These subcategories were then further explored and grouped into broader categories according to their similarities and differences. This iterative approach of constant comparison at different levels of abstraction facilitated the development of a category hierarchy, which continued until thematic saturation was achieved. In order to increase the methodological integrity and credibility of the study throughout the process, each of the primary coders performed the analysis independently and was regularly supervised by two experts (G.L.C. & S.G.). During these meetings, any discrepancies between coders were discussed as a group to reach agreement between coders using a consensus-oriented procedure [ 46 ]. In addition, possible expectations and biases of the coders regarding the emerging findings were critically examined with the supervisors, through self-reflective discussions, to ensure that the analysis remained adequately grounded in the data. 3. Results The final sample consisted of by 205 women (M age = 23.14 ± 5.85 years), of whom 46.8% (n = 96) reported a self-diagnosis of anorexia nervosa, 13.2% (n = 27) of bulimia nervosa and 16.6% (n = 34) of binge eating disorder. Participants reported a disease duration ranging from 1 to 16 years. The majority of participants are students (n = 137, 66.8%) and live with their parents (n = 144, 70.2%). The mean BMI was 20.94 (SD = 4.86) and 81.95% of the sample (n = 168) exceeded the clinical cut-off for the EDE-Q. According to DASS-21 scores, stress levels were mild in 49.27% (n = 101) and moderate in 28.78% (n = 59). Anxiety levels were mild in 18.05% (n = 37), moderate in 23.41% (n = 48), severe in 23.41% (n = 48) and extremely severe in 7.32% (n = 15). Finally, the depression scores were mild in 15.12% (n = 31), moderate in 43.90% (n = 90) and severe in 15.12% (n = 31). The mean scores for importance of change were 7.069 (SD = 2.54) and for ability to change were 5.396 (SD = 2.30). Descriptive statistics are reported in Table 1 . The results of the thematic analysis yielded a final system consisting of seven main themes, grouped into three clusters, which were derived from 18 sub-themes. These 18 sub-themes were in turn derived from a total of 327 units of meaning. A full description of the themes and sub-themes is showed in Table 2 . The seven main themes are illustrated in the following paragraphs, including some excerpts from participants’ responses. Cluster 1: Importance to change The first open-ended question asked users what motivations, feelings and desires drive individuals to try to recover from eating disorders. Participants’ responses formed the first cluster and were classified into three main themes according to the primary motivation articulated by respondents. These main themes are: (1) Emotional needs; (2) Coping with illness factors; (3) External motivation. Main theme 1: Emotional needs This main theme encompasses the responses of participants who identified emotional needs as the primary motivation for seeking treatment for ED. Specifically, many participants expressed the desire to “live a normal life”, which is used to describe a state of psychological well-being and the establishment of positive feelings about oneself, as reported by this participant: “I want to live my life in peace and learn to love myself again” ( P11). This main theme also includes the desire to reduce the negative emotions and feelings often triggered by EDs, such as shame, anxiety, low self-esteem and feelings of inadequacy. One participant stated: “ I am not happy and satisfied with my life and I feel exhausted from my anxiety and negative thoughts that harm me ” (P48). Finally, the desire to re-establish future-oriented thinking and life planning was also mentioned as a motivating factor. This desire indicates the possibility of imagining personal and relational goals without the limitations imposed by ED. “ The desire to try new things, to rediscover myself, to live without worrying about numbers, weight, and measurements, and to try to realize the dreams I had as a child. ” (P164). Main theme 2: Coping with illness factors The second main theme emerges from the statements made by participants who identified the ability to better manage the so-called 'disease factors' typical of ED as the primary impetus for change. In particular, managing anxiety around eating and socialising seems to have been identified as very important: “ I want to be able to dance in peace, enjoy my family and friends and all meals without having to turn down invitations for fear of what will be served .” (P43). Similarly, the desire to develop a positive body image and body acceptance was highlighted as one of the main motivations for change: “ I want to feel comfortable with my body again and see myself as attractive as I used to ” (P152). Moreover, many participants also expressed a desire to reduce the self-criticism and perfectionism that often underlie ED: “ I want a life that is not controlled by food, the freedom not to lose my mind if I have to change plans .” (P71). Main theme 3: External motivation The third main theme emerges from the statements of participants for whom the importance of change is not related to their own internal aspects, but rather to external factors and/or interpersonal relationships. One of the main motivations for change reported by these participants relates to the desire to no longer be perceived as worrying about their health by their caregivers (parents and/or partners), thus allowing them a greater psychological well-being. “ I want to make my family happy, without destroying myself and hurting them all the time .” (P22) Consequently, the desire to have more functional relationships and to improve the ability to care for loved ones (such as potential partners and/or children) was also identified as a key motivator for change. “ I would like to be able to start a family and have a child without fear of harming them ” (P97). Finally, the possibility of achieving professional fulfilment without being hindered by the eating disorder is also identified by some participants as an important factor for change: " I want to be able to finish my medical studies and become a good doctor ” (P188). Cluster 2: Low ability to change The second open-ended question explored the motivations behind participants' confidence in their ability to recover from ED. Of the 205 participants who responded to this question, 98 expressed low confidence in their ability to change (replies < 5 on a 1–10 Likert scale) and formed the second cluster. Based on the motivations given by the participants for their low perception of ability to change, two main themes emerged: (4) negative self-beliefs and (5) ED characteristics. Main theme 4: Negative self-beliefs The fourth main theme illustrates the responses of participants who feel unable to recover from an eating disorder because they believe they lack the essential psychological skills, qualities and characteristics to engage in the recovery process. In particular, some participants stated that they were unable to see themselves as individuals capable of achieving psychological well-being, while others expressed a lack of self-efficacy, feeling too weak and easily demoralized. These beliefs lead to a self-image of being unable to change. “ Although I want to live a normal life, I think I am too weak to really change things ” (P69). Furthermore, many participants expressed the belief that eating disorders are a condition from which complete recovery is impossible, requiring lifelong management and constant fear of relapse. This belief is one of the main motivations identified as contributing to the perceived low ability to change. “ I have improved a lot so far, but I don't think I can improve any more. I will always be afraid of relapsing at any moment ” (P14). Main theme 5: ED Characteristics The fifth main theme includes participants' statements suggesting that their low capacity for change is closely related to characteristics typical of eating disorders. Ambivalence towards the eating disorder was reported by the majority of participants, who stated that they were not ready to fully recover from the eating disorder, which is seen as a comfort zone—a well-known mechanism they fear leaving. “ I am afraid of change. Bulimia is both a great enemy and a certainty. Letting go of a certainty for uncertainty is a distressing situation for someone who is a control freak ” (P138). Similarly, many participants stated that they did not perceive themselves as being able to change because of their personal history of relapse despite treatment, which led them to this belief. “ Because I have often believed that I have recovered, only to relapse each time. It's like being in an endless tunnel ” (P72). Clusters 3: High ability to change 107 participants reported moderate to high confidence in their ability to change (responses > 5 on a Likert scale of 1 to 10) and formed the third cluster. Based on the responses of these participants, two main themes emerged as influencing the perceived level of ability to change: (6) internal resources and (7) external resources. Main theme 6: Internal resources The sixth main theme relates to participants' statements suggesting that the high perceived ability to change is determined by strong self-confidence and belief in one’s own abilities and psychological skills, which enable them to engage effectively in the recovery process. “ I believe in myself and I know I can get better again because it is something I really want, and I know I deserve it ” (P56). Furthermore, many participants stated that they relied on their own determination to achieve what they had set out to do, such as recovering from eating disorders. “ I have overcome many challenges in my life and I am determined to fight and overcome my eating disorder ” (P9). Main theme 7: External resources The final main theme consists of responses from participants who perceive a high capacity for change as facilitated by the presence of external resources. In particular, this theme includes statements about the importance of and trust in mental health professionals, who are seen as able to effectively support the patient during treatment and as a reliable resource to rely on. “ I have a strong desire to change, and I believe that with the help of a psychologist I could do it ” (P135). In addition to health professionals, another important form of support is found in social relationships, including family members, partners, and friends, who, according to some participants, can help facilitate the change process. “ I know I have the support of my parents, who have always been there for me and believe in me ” (P79). Table 1 Descriptive statistics of the sample (N = 205). Title 1 M (SD) n (%) Age 23.14 (5.846) BMI 20.941 (4.857) Occupation Student 137 (66.8) Part-time employed 18 (8.8) Full-time employed 27 (13.2) Unemployed 10 (4.9) Other 13 (6.3) Household composition Alone 14 (6.8) Parents 144 (70.2) Partner 27 (13.2) Roommates/Friends 14 (6.8) Other 6 (2.9) Self-reported diagnosis Anorexia Nervosa 96 (46.8) Bulimia Nervosa 27 (13.2) Binge-eating disorder 34 (16.6) Other ED 48 (23.4) Duration of illness (years) 5.481 (3.927) EDE-Q Restraint 3.792 (1.737) EDE-Q Eating Concern 3.752 (1.404) EDE-Q Shape Concern 4.892 (1.277) EDE-Q Weight Concern 4.538 (1.407) EDE-Q Total Score 4.243 (1.291) DASS-21 Stress 14.61 (5.062) DASS-21 Anxiety 10.58 (5.964) DASS-21 Depression 13.52 (5.998) BAS-2 18.78 (7.540) MR Importance to change 7.069 (2.536) MR Ability to change 5.396 (2.301) Note: EDE−Q: Eating Disorder Examination−Questionnaire. DASS−21: Depression, Anxiety and Stress Scale. BAS−2: Body Appreciation Scale−2. MR: Motivational Ruler Table 2 Results of thematic analysis of users’ answers of the two open-ended questions Clusters Main themes Sub-themes Example Importance to change (N = 205) Emotional needs (N = 102) Psychological well-being Wanting to start living again and be as happy as I was before ED Avoidance of negative thoughts and emotions I can no longer live like this. I want to stop feeling like a complete failure. Achievement of future planning goals Because I have understood that there is more to life than the disease. I want to recover so that I can set new goals, have a family and achieve personal fulfilment. Management of illness maintenance factors (N = 71) Food anxiety I am tired and exhausted of this life focused only on the eating disorder, I am tired of thinking only about eating and compensating and having anxiety about all the features related to food. Body acceptance Wearing the clothes I want without worrying about my weight. Self-criticism I want to live without thinking that everything I do is wrong and that I am incapable of doing anything. External motivation (N = 32) Concern for family carers To stop worrying my family and hearing that I cause them pain. Improve relationships To be more relaxed about dating and meeting new people without being afraid to show this side of me. Overcoming difficulties at work I have to be a trustworthy adult, especially in relation to my job. I'm a teacher, I can't show my pupils that I'm ill and have a difficult relationship with food. Low ability to change (N = 98) Negative self-beliefs (N = 59) Inability to cope with change These changes are too big for me, and I am quickly demoralized by the awareness of the size of this obstacle, because I know that I am too vulnerable. Impossibility of full recovery from EDs I can never say I'm fully recovered, at the best I’m coping better, but I know the triggers will always be there to activate me for the rest of my life. EDs characteristics (N = 39) Ambivalence toward the change I think I have the ability to change, but I can't really get into a perspective of real change for fear of getting out of a kind of "comfort zone" of situations related to my ED that are now an important part of my life. History of ED relapse Because I've tried so many times and when I thought I was out of it, I always failed. Now I am sure that I can never change this situation. High ability to change (N = 107) Internal resources (N = 61) Confidence in own psychological abilities I believe in myself all the way through to this day and I know I can win this battle too. Determination to achieve set goals I know that when I set a goal, I will do my best to achieve it, even if it takes a lot of time and efforts. External resources (N = 46) Psychological therapy I trust that if I start a psychological therapy I will be able to fully recover from EDs. Social support I am surrounded by people who love me and encourage me to change, and I know I can lean on them if I need to, so I think I can do it. 4. Discussion This study aimed to explore the motivational landscape of individuals with self-reported eating disorder. By analyzing data from users who have engaged with an Instagram recovery community, this research focused on an increasingly visible yet understudied population: individuals who seek help outside traditional clinical settings. The results of the thematic analysis explored individual’s perceptions of the importance to change and identified a range of motivational sources. Emotional needs (e.g., desire for peace, hope, and self-acceptance), illness management goals (e.g., managing anxiety, reducing food-related distress), and external motivations (e.g., concern for loved ones or professional aspirations) emerged as key drivers of change. This spectrum seems to mirror findings from qualitative work by Venturo-Conerly et al. [ 47 ], who highlighted how motivation is often shaped by the interplay of personal suffering, future visioning, and relational dynamics. Our findings are also consistent with the Self-Determination Theory, which posits a motivational continuum ranging from behaviors that are externally motivated to behaviors that are internally motivated [ 48 , 49 ]. Our findings support the importance of cultivating both internal (e.g., emotional needs) and external motivations (e.g., relationship with family members) to promote individual’s change in eating disorders. The recent review by Robinson et al. [ 9 ] showed that both illness perception (i.e. the negative impact of an ED) and relationship with others, including friends, family and parents, are associated with motivation to change in EDs. Given the importance to address the lack of motivation as a prominent barrier affecting engagement with treatment [ 28 , 9 ], the current study explored how the perceived ability to change—distinct from its importance —varied across people with ED. Specifically, participants with low confidence often reported entrenched negative self-beliefs, repeated relapses, or emotional dependency on the ED symptoms as barriers to treatment. On the contrary, individuals with high confidence reported stronger internal determination and access to supportive relationships—factors long associated with positive treatment trajectories [ 22 , 23 ]. From a clinical perspective, these findings underscore the necessity of early-stage, flexible interventions that validate ambivalence while gradually improving their confidence and enhancing readiness to change [ 20 ]. On the other hand, therapists who work with patients with eating disorders should prioritize the establishment of a warm and bonding therapeutic relationship to foster the main illness maintenance factors [ 50 ]. In these clinical setting therapists’ personal characteristics, such as empathic, supportive attitudes, authenticity and the tendency to self-disclose, need to be preserved as an important predictor on therapy outcome and the quality of the therapeutic relationship [ 50 ]. Interventions such as Motivational Interviewing [ 10 ] and Motivational Enhancement Therapy can be particularly useful in this regard, especially when adapted to the individual's stage of change [ 17 ]. Moreover, the findings confirm the importance of addressing eating disorders more broadly—including subthreshold and atypical presentations—which are often overlooked in research and services, despite being associated with significant impairment and risk of chronicity [ 27 ]. A major contribution of this study is its focus on help-seeking through social media platforms. Although there is research evidence that appearance-related social media use may trigger dysfunctional eating behaviors by perpetuating harmful idealized body ideals [ 51 , 29 , 31 , 30 ], they can also be used as a tool to assist in recovery [ 35 , 34 ]. For example, online recovery communities can offer positive support for people with eating disorders by providing safe spaces for discussion and peer support [ 33 ]. In the current study, we surveyed participants from a Instagram online community—run by professionals and structured to offer evidence-based psychoeducation and peer modeling and strengthen motivation [ 38 ]. Although some recent research has explored the ED recovery content and post created in social media such as Instagram and TiKTok [ 33 , 36 , 34 ], the current study is the first to explore users’ view of their motivation to change. In light of these findings, it is crucial to emphasize the clinical importance of facilitating early access to specialized services for individuals with EDs. Although online recovery communities can provide valuable motivational support, formal clinical interventions remain essential to address the underlying maintenance factors of EDs and to foster self-efficacy in change processes [ 25 , 28 ]. Timely access to specialized treatment is associated with improved outcomes and reduced chronicity [ 27 ]. Therefore, integrating digital psychoeducation via social media with accessible pathways to professional care may be a promising strategy to bridge the treatment gap and improve recovery trajectories [ 38 ]. Taken together, our findings highlighted the complexity of social media users’ ambivalence towards recovery. Consistent with previous evidence [ 11 , 52 ], in the current study many participants expressed a simultaneous desire for change and an attachment to the disorder. This tension—seen across diagnostic groups—was particularly evident in those with AN, for whom ED may serve identity-affirming functions. However, similar patterns also emerged in individuals with BN and BED, particularly in relation to emotional regulation and body dissatisfaction. These dynamics are in line with the cognitive-interpersonal maintenance model [ 16 , 53 ], which emphasizes the role of both individual traits (e.g., perfectionism, rigidity, impulsivity) and interpersonal factors in maintaining disordered eating behaviors. However, social media recovery community can be helpful to address participants’ ambivalence to change. The potential of the online community to bridge the gap between illness onset and treatment is particularly relevant. Delays in accessing care are common and associated with worse outcomes [ 25 ], yet online resources may offer psychoeducational scaffolding and motivational support during this waiting period. These online platforms may also provide a safe and familiar space for those who do not meet full diagnostic criteria but still experience clinically significant disordered eating. In line with stepped-care models, digital interventions could function as early-stage tools, offering psychoeducation and motivational support that prepare individuals for formal treatment when they are ready, while simultaneously reducing stigma and enhancing health literacy [ 54 ]. Several strengths characterize this study. First, it captures a real-world, underrepresented population that engages in non-traditional help-seeking, thus offering ecological validity. Second, the use of a widely accessible platform like Instagram increases the generalizability of findings to current digital behavior patterns, especially among younger demographics. Nevertheless, some limitations must be acknowledged. The sample was composed exclusively of self-identified female participants, limiting the generalizability to other genders. The reliance on self-report data and non-verified diagnoses introduces potential biases. Additionally, because participants were already motivated enough to seek information online, the sample may not capture individuals in the earliest (precontemplation) stage of change. The use of qualitative analysis, which, while providing rich and in-depth insights, may be subject to researcher bias and limited generalizability to different clinical populations. Finally, the cross-sectional design prevents any causal inference regarding motivation and help-seeking behaviors. 5. Conclusions This study highlights the promise of integrating social media–based psychoeducational strategies into early intervention frameworks for EDs. Digital profiles on Instragram such as # Dicci come aiutarti can serve not only to disseminate recovery-oriented content, but also to identify at-risk individuals, offer emotional validation, and encourage formal help-seeking. These platforms could be leveraged to assess readiness for change in real time and provide tailored content according to motivational stage—potentially using tools like interactive polls, direct messaging, or adaptive story formats. Future research should investigate the longitudinal impact of digital interventions on motivation, treatment initiation, and symptom change. It would also be important to explore male and non-binary experiences with similar help-seeking behaviors and to examine the potential for social media–based interventions to complement therapist-guided approaches in hybrid care models. Abbreviations The following abbreviations are used in this manuscript: ED/EDs Eating Disorder/Eating Disorders AN Anorexia Nervosa BN Bulimia Nervosa BED Binge Eating Disorder CBT-E Enhanced Cognitive Behaviour Therapy MI Motivational Interviewing MET Motivational Enhancement Therapy IG Instagram BMI Body Mass Index EDE-Q Eating Disorder Examination Questionnaire DASS-21 Depression, Anxiety and Stress Scale BAS-2 Body Appreciation Scale Declarations Competing Interests The authors declare that this proposal was con-ducted in the absence of any commercial or financial relationships that could be construed as po-tential conflicts of interest. Ethics approval and consent to participate The study was conducted in accordance with the Dec-laration of Helsinki. Ethical review and approval were waived for this study due to its prelimi-nary nature. Informed Consent Statement: Informed consent was obtained from all subjects in-volved in the study. Funding The study is funded by the Italian Ministry of University and Research as part of a na-tional grant (PRIN 2022 PNRR), Prot. P202237PFB (Finanziato dall'Unione Europea – Next Gen-eration EU”). Author Contribution Conceptualization, G.A., A.T., G.L.C., S.G.; methodology, G.A., A.T., G.L.C., S.G; software, G.A.; validation, G.A., A.T., G.L.C., S.G; formal analysis, G.A., A.T.; investi-gation, G.A., G.L.C. ; resources, G.A., A.T., G.L.C., S.G; data curation, G.A., A.T.; writing—original draft preparation, G.A., G.L.C., A.T. and S.G.; writing—review and editing, G.A., G.L.C., A.T. and S.G.; visualization, G.A and A.T.; supervision, G.A., G.L.C. and S.G.; project administration, G.A., and S.G.; funding acquisition, G.A., A.T. All authors have read and agreed to the published ver-sion of the manuscript. Acknowledgement We are grateful to the recovered individuals, actually content creators, who contributed to the development of the contents offered through the #Dicci Come Aiutarti IG profile. We acknowledge the support of psychology students and external volunteers across Italy that with passion and enthusiasm worked hard to the dissemination of our contents on a weekly basis. Data Availability The dataset generated for this study is available on request from the corresponding author. References American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Text revision. Washington (DC): American Psychiatric Publishing; 2022. Attia E, Walsh BT. Eating disorders: a review. JAMA. 2025;333:1242–52. 10.1001/jama.2025.0132 . Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet. 2020;395:899–911. 10.1016/S0140-6736(20)30059-3 . Hilbert A, Hoek HW, Schmidt R. Evidence-based clinical guidelines for eating disorders: International comparison. Curr Opin Psychiatry. 2017;30:423–37. 10.1097/YCO.0000000000000360 . Monteleone AM, Pellegrino F, Croatto G, et al. Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses. Neurosci Biobehav Rev. 2022;142:104857. 10.1016/j.neubiorev.2022.104857 . Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: Findings from a rapid review. J Eat Disord. 2023;11:175. 10.1186/s40337-023-00886-w . Dalle Grave R, Calugi S, Sartirana M, Fairburn CG. Enhanced cognitive behavior therapy for eating disorders: A transdiagnostic treatment. New York (NY): Guilford Press; 2020. Dalle Grave R, Sartirana M, Dalle Grave A, Calugi S. Effectiveness of enhanced cognitive behaviour therapy for patients aged 14 to 25: A promising treatment for anorexia nervosa in transition-age youth. Eur Eat Disord Rev. 2023. 10.1002/erv.3019 . Robinson L, Flynn M, Cooper M. Individual differences in motivation to change in individuals with eating disorders: A systematic review. Int J Eat Disord. 2024;57:1069–87. 10.1002/eat.24178 . Cooper Z, Bailey-Straebler S, McClelland J. Motivational interviewing for eating disorders. In: Miller WR, Rollnick S, editors. Motivational interviewing: Helping people change. 3rd ed. New York (NY): Guilford Press; 2016. pp. 536–49. Treasure J, Schmidt U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord. 2013;1:13. 10.1186/2050-2974-1-13 . Aloi M, Rania M, Lo Coco G, Carcione A, Castellini G, Waldherr K, et al. Editorial: Psychosocial risk factors in the development, maintenance and treatment outcome of eating disorders. Front Psychol. 2024;15:1486941. 10.3389/fpsyg.2024.1486941 . Clausen L, Lübeck M, Jones A. Motivation to change in the eating disorders: a systematic review. Int J Eat Disord. 2013;46:755–63. 10.1002/eat.22156 . Sansfaçon J, Booij L, Gauvin L, Fletcher E, Islam F, Israel M, et al. Pretreatment motivation and therapy outcomes in eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2020;53:1879–900. 10.1002/eat.23376 . Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a 'transdiagnostic' theory and treatment. Behav Res Ther. 2003;41:509–28. 10.1016/S0005-7967(02)00088-8 . Cardi V, Albano G, Ambwani S, et al. A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa. Psychol Med. 2020;50(15):2610–21. 10.1017/S0033291719002824 . Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390–5. 10.1037/0022-006X.51.3.390 . Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12:38–48. 10.4278/0890-1171-12.1.38 . Treasure J, Willmott D, Ambwani S, Cardi V, Clark Bryan D, Rowlands K, et al. Cognitive interpersonal model for anorexia nervosa revisited: the perpetuating factors that contribute to the development of the severe and enduring illness. J Clin Med. 2020;9:630. 10.3390/jcm9030630 . Iyar MM, Cox DW, Kealy D, Srikameswaran S, Geller J. Is stage of change enough? Confidence as a predictor of outcome in inpatient treatment for eating disorders. Int J Eat Disord. 2019;52:283–91. 10.1002/eat.23026 . Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2015;48:946–71. 10.1002/eat.22411 . Linardon J, Messer M, Lee S, Andrew E. Individual differences in motivation to change and eating disorder psychopathology: a systematic review and meta-analysis. Int J Eat Disord. 2022;55:295–309. 10.1002/eat.23698 . Denison-Day J, Muir S, Newell C, Bennett SD. Motivational interventions in eating disorders: a systematic review and meta-analysis. Clin Psychol Rev. 2018;62:1–11. 10.1016/j.cpr.2018.05.005 . Fitzsimmons-Craft EE, Balantekin KN, Graham AK, Smolar L, Park D, Mysko C, et al. Results of disseminating an online screen for eating disorders across the U.S.: reach, respondent characteristics, and unmet treatment need. Int J Eat Disord. 2019;52:721–9. 10.1002/eat.23043 . Ali K, Farrer L, Fassnacht DB, Gulliver A, Bauer S, Griffiths KM. Perceived barriers and facilitators towards help-seeking for eating disorders: a systematic review. Int J Eat Disord. 2017;50:9–21. 10.1002/eat.22598 . Griffiths S, Rossell SL, Mitchison D, Murray SB, Mond JM. Pathways into treatment for eating disorders: a quantitative examination of treatment barriers and treatment attitudes. Eat Disord. 2018;26:556–74. 10.1080/10640266.2018.1518086 . Hart LM, Granillo MT, Jorm AF, Paxton SJ. Unmet need for treatment in the eating disorders: a systematic review of eating disorder-specific treatment seeking among community cases. Clin Psychol Rev. 2011;31:727–35. 10.1016/j.cpr.2011.03.004 . Daugelat MC, Pruccoli J, Schag K, Giel KE. Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: a systematic review synthesising patient, caregiver and clinician perspectives. Eur Eat Disord Rev. 2023;31:752–68. 10.1002/erv.2999 . Holland G, Tiggemann M. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image. 2016;17:100–10. 10.1016/j.bodyim.2016.02.008 . Sharpe H, Vidal CA. Scoping literature review of the associations between highly visual social media use and eating disorders and disordered eating: a changing landscape. J Eat Disord. 2023;11:170. 10.1186/s40337-023-00898-6 . Rodgers RF, Melioli T, Laconi S, Bui E, Chabrol H. Internet addiction symptoms, disordered eating, and body image avoidance. Cyberpsychol Behav Soc Netw. 2013;16:56–60. 10.1089/cyber.2012.1570 . Ging D, Garvey S. Written in these scars are the stories I can't explain’: a content analysis of pro-ana and thinspiration image sharing on Instagram. New Media Soc. 2018;20:1181–200. 10.1177/1461444816687288 . Au ES, Cosh SM. Social media and eating disorder recovery: an exploration of Instagram recovery community users and their reasons for engagement. Eat Behav. 2022;46:101651. 10.1016/j.eatbeh.2022.101651 . Herrick SSC, Hallward L, Duncan LR. This is just how I cope': an inductive thematic analysis of eating disorder recovery content created and shared on TikTok using #EDrecovery. Int J Eat Disord. 2021;54:516–26. Bohrer BK, Foye U, Jewell T. Recovery as a process: exploring definitions of recovery in the context of eating-disorder-related social media forums. Int J Eat Disord. 2020;53:1219–23. Goh AQY, Lo NYW, Davis C, et al. #EatingDisorderRecovery: a qualitative content analysis of eating disorder recovery-related posts on Instagram. Eat Weight Disord. 2022;27:1535–45. 10.1007/s40519-021-01279-1 . Kenny TE, Boyle SL, Lewis SP. #recovery: understanding recovery from the lens of recovery-focused blogs posted by individuals with lived experience. Int J Eat Disord. 2019;53:1234–43. 10.1002/eat.23221 . Albano G, Lo Coco G, Teti A, Semola M, Valenti F, Pastizzaro CD, et al. #How can we help you? an Instagram-based online self-help for eating disorders. Sustainability. 2023;15:2389. 10.3390/su15032389 . Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord. 1994;16:363–70. Calugi S, Milanese C, Sartirana M, El Ghoch M, Sartori F, Geccherle E, et al. The Eating Disorder Examination Questionnaire: reliability and validity of the Italian version. Eat Weight Disord. 2017;22:509–14. 10.1007/s40519-016-0276-6 . Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33:335–43. 10.1016/0005-7967(94)00075-U . Bottesi G, Ghisi M, Altoè G, Conforti E, Melli G, Sica C. The Italian version of the Depression Anxiety Stress Scales-21: factor structure and psychometric properties on community and clinical samples. Compr Psychiatry. 2015;60:170–81. Tylka TL, Wood-Barcalow NL. The Body Appreciation Scale-2: item refinement and psychometric evaluation. Body Image. 2015;12:53–67. Casale S, Prostamo A, Giovannetti S, Fioravanti G. Translation and validation of an Italian version of the Body Appreciation Scale-2. Body Image. 2021;37:1–5. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. 10.1191/1478088706qp063oa . Hill CE. Consensual qualitative research (CQR): methods for conducting psychotherapy research. In: Gelo OCG, Pritz A, Rieken B, editors. Psychotherapy research: Foundations, process, and outcome. Vienna (Austria): Springer; 2015. pp. 485–99. 10.1007/978-3-7091-1382-0_23 . Venturo-Conerly KE, Wasil AR, Shingleton RM, Weisz JR. A qualitative investigation of factors promoting motivation for eating disorder recovery. Int J Eat Disord. 2020;53:554–63. 10.1002/eat.23246 . Ryan RM, Deci EL. Self-determination theory: basic psychological needs in motivation, development, and wellness. New York (NY): Guilford Press; 2017. Steiger H. Evidence-informed practices in the real-world treatment of people with eating disorders. Eat Disord. 2017;25:173–81. 10.1080/10640266.2016.1269558 . Albano G, Teti A, Scrò A, Bonfanti RC, Fortunato L, Lo Coco G. A systematic review on the role of therapist characteristics in the treatment of eating disorders. Res Psychother. 2024;27(2):750. 10.4081/ripppo.2024.750 . Bonfanti RC, Teti A, Albano G, Melchiori F, Raffard S, Rodgers R, et al. The association between social comparison in social media, body image concerns and eating disorder symptoms: a systematic review and meta-analysis. Body Image. 2025;52:101841. 10.1016/j.bodyim.2024.101841 . Vitousek K, Watson S, Wilson GT. Enhancing motivation for change in treatment-resistant eating disorders. Clin Psychol Rev. 1998;18:391–420. 10.1016/S0272-7358(98)00012-9 . Albano G, Rowlands K, Baciadonna L, Lo Coco GL, Cardi V. Interpersonal difficulties in obesity: a systematic review and meta-analysis to inform a rejection sensitivity-based model. Neurosci Biobehav Rev. 2019;107:846–61. 10.1016/j.neubiorev.2019.09.039 . Holmberg C, Berg C, Dahlgren J, Lissner L, Chaplin JE. Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information. Health Inf J. 2018;24:202–12. 10.1177/1460458216663023 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Nov, 2025 Read the published version in BMC Psychiatry → Version 1 posted Editorial decision: Revision requested 18 Aug, 2025 Reviews received at journal 18 Aug, 2025 Reviews received at journal 16 Aug, 2025 Reviews received at journal 05 Aug, 2025 Reviewers agreed at journal 18 Jul, 2025 Reviewers agreed at journal 17 Jul, 2025 Reviewers agreed at journal 11 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers invited by journal 08 Jul, 2025 Editor invited by journal 03 Jul, 2025 Editor assigned by journal 01 Jul, 2025 Submission checks completed at journal 01 Jul, 2025 First submitted to journal 23 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6956741","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":482963145,"identity":"a7229226-6b25-4b13-8669-51ceaf04b6e4","order_by":0,"name":"Gaia Albano","email":"","orcid":"","institution":"University of Palermo","correspondingAuthor":false,"prefix":"","firstName":"Gaia","middleName":"","lastName":"Albano","suffix":""},{"id":482963146,"identity":"3331e2c8-1dd1-4422-b10f-c8b40e58710a","order_by":1,"name":"Arianna Teti","email":"","orcid":"","institution":"University of Palermo","correspondingAuthor":false,"prefix":"","firstName":"Arianna","middleName":"","lastName":"Teti","suffix":""},{"id":482963147,"identity":"8946c6e1-6aea-4097-babe-e04d66d3d4f0","order_by":2,"name":"Salvatore Gullo","email":"","orcid":"","institution":"University of Palermo","correspondingAuthor":false,"prefix":"","firstName":"Salvatore","middleName":"","lastName":"Gullo","suffix":""},{"id":482963148,"identity":"8aa3231d-b742-4e9e-8fe8-a4719feb65bf","order_by":3,"name":"Gianluca Lo Coco","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBAC/mYg8QDEYocIyDEwMDYAaQmcWiQOA4kEEIsZImAM04JTjwEDmpbEBphhOLWwMz97kNhmJ8/AzHzww4cam/QNt5vbHvxgsKjDqYWZzdwgsS3ZsIGZLVlyxrG03A13DrYb9uBxmOFhBjOJxLYDjA3MPGbMvA2HczfcSGyT4MHnl8Ps30Ba7GFa0g2AWiT/4NXCA7YlEaYlAaRFGp8tEod5yiQSziUnt0H9YjjzRmK7sYyBhGQDDi38/ce3SXwos7PtZ28Gh5g83430Zw/fVNTx47IFDthQ2QYENeDWPgpGwSgYBaOAAQDsk0zhIkJ04AAAAABJRU5ErkJggg==","orcid":"","institution":"University of Palermo","correspondingAuthor":true,"prefix":"","firstName":"Gianluca","middleName":"Lo","lastName":"Coco","suffix":""}],"badges":[],"createdAt":"2025-06-23 12:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6956741/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6956741/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-025-07591-9","type":"published","date":"2025-11-14T15:57:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":96106038,"identity":"88234977-c587-4ac4-a3dd-a1c7ed3ae8a6","added_by":"auto","created_at":"2025-11-17 16:12:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":831286,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6956741/v1/b3c7c848-ba2d-4300-b746-4c45c6c908ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Navigating an Instagram Community for Eating Disorder Recovery: A Qualitative Study of Users' Motivation and Confidence to Change","fulltext":[{"header":"1. Background","content":"\u003cp\u003eEating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), are complex psychiatric conditions characterized by severe disturbances in eating behaviors, thoughts, and emotions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These disorders are associated with significant physical complications, psychological suffering, and impaired social functioning [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Evidence-based clinical guidelines agree that patients with EDs should be treated with psychological therapies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] such as cognitive behavioral therapy, family therapy, or more structured specialised treatments such as Maudsley model of anorexia treatment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Among evidence-based psychological treatments, enhanced cognitive behavioral therapy (CBT-E) has demonstrated substantial effectiveness, particularly for individuals with BN and BED [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recent studies report that approximately 65% of patients undergoing CBT-E achieve sustained full remission [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNevertheless, treatment engagement and motivation to change remain significant challenges that can significantly impact treatment outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], especially in individuals with AN who often experience marked ambivalence toward recovery [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Motivation to change has been recognized as a crucial predictor of treatment adherence and outcome [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Individuals may simultaneously desire recovery and adhere to their disorder, which may provide perceived benefits such as control, emotional regulation, or social validation through weight loss [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmbivalence is often sustained by cognitive and personality traits such as perfectionism, obsessive-compulsiveness, and rigid thinking [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], as well as negatively reinforcing behaviors like dietary restriction or binge-purge cycles [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These processes can be conceptualized through theoretical frameworks such as the Transtheoretical Model of Change [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and the Cognitive-Interpersonal Maintenance Model [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], which underscore the role of individual and relational dynamics in the persistence of EDs and the need for tailored interventions. The importance of confidence to change (i.e. the expectation people have about their ability to make changes) has also been highlighted as a prognostic factor in ED [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] given that individuals with high levels of confidence are more likely to persevere in challenging situations such as relapses [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn light of these challenges, growing research attention has been directed toward motivational interventions, such as Motivational Interviewing (MI) and Motivational Enhancement Therapy (MET). A recent systematic review and meta-analysis by Linardon et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] showed that these interventions can significantly improve readiness to change and contribute to improvements in both ED psychopathology and body mass index. Moreover, Denison-Day et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] conducted a systematic review assessing the effectiveness of clinical interventions explicitly aimed at increasing motivation among ED patients. While motivational levels tended to improve across all treatment modalities, the review highlighted that motivational interventions were particularly effective compared to low-intensity treatments, although their added value over standard therapies remains uncertain.\u003c/p\u003e\u003cp\u003eDespite the clinical relevance of motivational work, a substantial proportion of individuals with EDs do not engage with formal treatment services [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Barriers such as stigma, geographical limitations, financial obstacles, and a lack of specialized services contribute to this treatment gap [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Patients reported that shame, stigma and guilt as well as ambivalence and lack of motivation were the most prominent barriers affecting their engagement with treatment [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. It is worth noting that people with subthreshold or atypical ED symptoms may have limited insight into their condition and poor motivation to change, with a high risk of chronicity and poorer long-term outcomes.\u003c/p\u003e\u003cp\u003eIn recent years, online communities for ED recovery have emerged as a prominent platform for individuals with EDs to seek information and support related to their struggles and recovery. Although the negative influence of social media for development of disordered eating behaviors [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] through the exposure to online proEDs contents [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], the role of online recovery communities which are present in social media such as Instagram or TiKTok has been recently examined [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Research has suggested that these pro-recovery platforms can offer positive support for people with ED as they provide safe spaces for discussion and peer support [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. More specifically, it was suggested that the use of online recovery communities could be beneficial in reaching individuals with atypical disordered eating or subthreshold symptoms who do not have access to traditional services or are not ready to seek professional help [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo date, it remains unclear which individuals with disordered eating turn to online pro-recovery communities rather than receiving ED treatment, and what their motivations for change might be. Given the importance of stages of change and confidence in improving ED symptoms [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the current study aims to explore users' perceived importance and confidence to change from an ED recovery Instagram (IG) community using a qualitative approach. Understanding community users' stages of change and treatment-seeking attitudes is essential for designing tailored and accessible interventions [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and informing strategies for personalized and accessible digital interventions that promote engagement and recovery within online communities [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cb\u003eParticipants and Procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants were recruited from the Italian #How can we help you?\u0026rdquo; IG community in the first six months after going live. All individuals who contacted the Instagram page to inquire about treatment options for eating disorders were invited to participate in the study via a link to an online questionnaire. Participants were included in the study if they met the following inclusion criteria: (a) being older than 18 years, (b) following the #How Can We Help You? Instagram page, (c) having contacted the page to inquire about eating disorders treatment options.\u003c/p\u003e\u003cp\u003eDuring the recruitment phase of the study, 378 individuals contacted the Instagram page to request information about possible treatment for eating disorders, of whom 54.23% agreed to participate in the study and completed the questionnaire. The final study sample consisted of 205 women (mean age\u0026thinsp;=\u0026thinsp;23.14\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85 years).\u003c/p\u003e\u003cp\u003e All procedures contributing to this work complied with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All procedures involving human subjects/patients were approved by the local Ethics Committee (masked for review). Written informed consent was obtained from all participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003e#How Can We Help You?\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\"#How Can We Help You?: An Instagram-Based Online Self-Help for Eating Disorders,\" is a ED recovery Instagram community [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] that aims to provide digital support to individuals struggling within EDs. Various components of support are used, such as psychoeducational posts, interactive stories, and Q\u0026amp;A chat sessions which are designed to actively engage participants and provide practical information and emotional support. Content is curated by mental health professionals, and integrates evidence-based strategies such as emotion regulation, coping mechanisms, and mindfulness techniques. Moreover, the project provides IG directs delivered by content creators \u0026ndash; individuals with a significant online presence who have lived experience of eating disorders. As well as helping to spread educational and supportive messages through their profiles, these content creators engage directly with users through published interviews on Instagram (Direct), facilitated by our clinical research team.\u003c/p\u003e\u003cp\u003eScientific content related to eating disorders is published weekly in the form of posts, stories or reels and relates to three macro areas: 1) positive thinking, 2) change as an opportunity, which promotes the importance of change (motivation), and 3) the maintenance factors of an ED.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eUsers were invited to complete an online assessment that included a sociodemographic survey and self-report measures.\u003c/p\u003e\u003cp\u003eThe online survey consisted of the following questionnaires:\u003c/p\u003e\u003cp\u003e\u003cem\u003eDemographic and clinical survey\u003c/em\u003e, to collect information on age, geographical area, years of education, employment and social status, self-diagnosis of EDs, duration of illness, time of onset of illness, self-reported body mass index (BMI).\u003c/p\u003e\u003cp\u003eThe \u003cem\u003eEating Disorder Examination Questionnaire\u003c/em\u003e [EDE-Q; 39, 40] is a 28-item self-report questionnaire to assess attitudes and behaviors associated with eating disorders. All items are rated on a 0\u0026ndash;6 Likert scale (with higher scores reflecting greater severity). The measure comprises a Global scale and four subscales (Restraint, Eating Concern, Weight Concern, and Shape Concern), with higher scores indicate higher symptomatology. In the present study, the internal consistency of all subscales and of the score good (ω ranges: .767-.881).\u003c/p\u003e\u003cp\u003eThe \u003cem\u003eDepression, Anxiety and Stress Scale\u003c/em\u003e [DASS-21; 41, 42] is a 21-item self-report measure of patients\u0026rsquo; psychological distress over the past 7 days. Items are scored on a four-point Likert scale. It includes three subscales (i.e., anxiety, depression, and stress). In the present study, the internal consistency of all subscales and of the score were good (ω ranges: .895-.922).\u003c/p\u003e\u003cp\u003eThe \u003cem\u003eBody Appreciation Scale\u003c/em\u003e [BAS-2; 43, 44] is a 12-item self-report measure that assess body appreciation. All items are scored on a 5-point Likert scale; higher scores reflect higher body appreciation. In this study, the internal consistency was excellent (ω\u0026thinsp;=\u0026thinsp;.934).\u003c/p\u003e\u003cp\u003e\u003cem\u003eImportance and confidence in own ability to change\u003c/em\u003e were assessed using two ad hoc Likert-type items, scored from 1 (\u0026ldquo;not important at all\u0026rdquo; / \u0026ldquo;not confident at all\u0026rdquo;) to 10 (\u0026ldquo;extremely important\u0026rdquo; / \u0026ldquo;extremely confident in my ability to change\u0026rdquo;). Higher scores suggest greater motivation and ability to change. In addition, the perceived importance and ability for change were also investigated through two open-ended questions, to which participants were asked to respond in as much detail and as comprehensively as possible. The two open-ended questions were: 1) \u0026ldquo;What are the motivations, needs, and wishes that lead you to change?\u0026rdquo; and 2) \u0026ldquo;How much do you feel that you can change? What are your reasons for indicating this score?\u0026rdquo;. These items have already been used in several RCT studies investigating motivation levels in eating disorders [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData from the questionnaires were analysed using descriptive statistics to explore the characteristics of the sample.\u003c/p\u003e\u003cp\u003eQualitative data resulted from the users\u0026rsquo; responses to the two open-ended questions were analysed using inductive data-driven thematic analysis [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] with a realistic approach to allow a more direct focus on the users\u0026rsquo; perspectives. The use of an inductive approach was driven by the exploratory nature of the study. The analysis was carried out by two clinical psychologists experienced in thematic analysis and EDs (G.A. \u0026amp; A.T.) using the following procedure.\u003c/p\u003e\u003cp\u003eUsers' responses were first grouped into two main categories, each corresponding to one of the open-ended questions (i.e. motivation to change and ability to change). In addition, a thematic analysis of the responses to the motivation question was conducted (i.e., \"What are the motivations, needs, and wishes that lead you to change?\"). This analysis was conducted across the entire sample, thus forming the first cluster of the analysis. Thematic analysis was also employed to code participants' responses to the second open-ended question, the purpose of which was to explore the motivations behind participants' confidence in their ability to recover from ED (\"How much do you feel that you can change?\"). Participants' responses were initially divided into two groups: the 'high ability to change group' (composed of individuals who rated their ability to change as \u0026ge;\u0026thinsp;5 on the 10-point Likert scale) and the 'low ability to change group' (composed of individuals who rated their ability to change as less than 5). The two aforementioned groups constituted the second and third clusters, respectively. Subsequent to this procedure, the responses within the three resulting clusters were analysed according to the thematic analysis procedure. First, the psychologists immersed themselves in the data, reading and re-reading users\u0026rsquo; responses and using notes to capture emerging insights. Next, the text was divided into units of meaning, identified as the smallest parts that convey a single theme. Each segment was then given a code that reflected its core meaning while remaining faithful to the participants' own expressions. The codes were then compared and organized into clusters, based on their similarities and contrasts, which form our subcategories. These subcategories were then further explored and grouped into broader categories according to their similarities and differences. This iterative approach of constant comparison at different levels of abstraction facilitated the development of a category hierarchy, which continued until thematic saturation was achieved.\u003c/p\u003e\u003cp\u003eIn order to increase the methodological integrity and credibility of the study throughout the process, each of the primary coders performed the analysis independently and was regularly supervised by two experts (G.L.C. \u0026amp; S.G.). During these meetings, any discrepancies between coders were discussed as a group to reach agreement between coders using a consensus-oriented procedure [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn addition, possible expectations and biases of the coders regarding the emerging findings were critically examined with the supervisors, through self-reflective discussions, to ensure that the analysis remained adequately grounded in the data.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eThe final sample consisted of by 205 women (M\u003csub\u003eage\u003c/sub\u003e = 23.14\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85 years), of whom 46.8% (n\u0026thinsp;=\u0026thinsp;96) reported a self-diagnosis of anorexia nervosa, 13.2% (n\u0026thinsp;=\u0026thinsp;27) of bulimia nervosa and 16.6% (n\u0026thinsp;=\u0026thinsp;34) of binge eating disorder. Participants reported a disease duration ranging from 1 to 16 years. The majority of participants are students (n\u0026thinsp;=\u0026thinsp;137, 66.8%) and live with their parents (n\u0026thinsp;=\u0026thinsp;144, 70.2%). The mean BMI was 20.94 (SD\u0026thinsp;=\u0026thinsp;4.86) and 81.95% of the sample (n\u0026thinsp;=\u0026thinsp;168) exceeded the clinical cut-off for the EDE-Q. According to DASS-21 scores, stress levels were mild in 49.27% (n\u0026thinsp;=\u0026thinsp;101) and moderate in 28.78% (n\u0026thinsp;=\u0026thinsp;59). Anxiety levels were mild in 18.05% (n\u0026thinsp;=\u0026thinsp;37), moderate in 23.41% (n\u0026thinsp;=\u0026thinsp;48), severe in 23.41% (n\u0026thinsp;=\u0026thinsp;48) and extremely severe in 7.32% (n\u0026thinsp;=\u0026thinsp;15). Finally, the depression scores were mild in 15.12% (n\u0026thinsp;=\u0026thinsp;31), moderate in 43.90% (n\u0026thinsp;=\u0026thinsp;90) and severe in 15.12% (n\u0026thinsp;=\u0026thinsp;31). The mean scores for importance of change were 7.069 (SD\u0026thinsp;=\u0026thinsp;2.54) and for ability to change were 5.396 (SD\u0026thinsp;=\u0026thinsp;2.30). Descriptive statistics are reported in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe results of the thematic analysis yielded a final system consisting of seven main themes, grouped into three clusters, which were derived from 18 sub-themes. These 18 sub-themes were in turn derived from a total of 327 units of meaning. A full description of the themes and sub-themes is showed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe seven main themes are illustrated in the following paragraphs, including some excerpts from participants\u0026rsquo; responses.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCluster 1: Importance to change\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe first open-ended question asked users what motivations, feelings and desires drive individuals to try to recover from eating disorders. Participants\u0026rsquo; responses formed the first cluster and were classified into three main themes according to the primary motivation articulated by respondents. These main themes are: (1) Emotional needs; (2) Coping with illness factors; (3) External motivation.\u003c/p\u003e\u003cp\u003e\u003cem\u003eMain theme 1: Emotional needs\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis main theme encompasses the responses of participants who identified emotional needs as the primary motivation for seeking treatment for ED. Specifically, many participants expressed the desire to \u0026ldquo;live a normal life\u0026rdquo;, which is used to describe a state of psychological well-being and the establishment of positive feelings about oneself, as reported by this participant: \u003cem\u003e\u0026ldquo;I want to live my life in peace and learn to love myself again\u0026rdquo; (\u003c/em\u003eP11).\u003c/p\u003e\u003cp\u003eThis main theme also includes the desire to reduce the negative emotions and feelings often triggered by EDs, such as shame, anxiety, low self-esteem and feelings of inadequacy. One participant stated: \u0026ldquo;\u003cem\u003eI am not happy and satisfied with my life and I feel exhausted from my anxiety and negative thoughts that harm me\u003c/em\u003e\u0026rdquo; (P48).\u003c/p\u003e\u003cp\u003eFinally, the desire to re-establish future-oriented thinking and life planning was also mentioned as a motivating factor. This desire indicates the possibility of imagining personal and relational goals without the limitations imposed by ED. \u0026ldquo;\u003cem\u003eThe desire to try new things, to rediscover myself, to live without worrying about numbers, weight, and measurements, and to try to realize the dreams I had as a child.\u003c/em\u003e\u0026rdquo; (P164).\u003c/p\u003e\u003cp\u003e\u003cem\u003eMain theme 2: Coping with illness factors\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe second main theme emerges from the statements made by participants who identified the ability to better manage the so-called 'disease factors' typical of ED as the primary impetus for change. In particular, managing anxiety around eating and socialising seems to have been identified as very important: \u0026ldquo;\u003cem\u003eI want to be able to dance in peace, enjoy my family and friends and all meals without having to turn down invitations for fear of what will be served\u003c/em\u003e.\u0026rdquo; (P43).\u003c/p\u003e\u003cp\u003eSimilarly, the desire to develop a positive body image and body acceptance was highlighted as one of the main motivations for change: \u0026ldquo;\u003cem\u003eI want to feel comfortable with my body again and see myself as attractive as I used to\u003c/em\u003e\u0026rdquo; (P152).\u003c/p\u003e\u003cp\u003eMoreover, many participants also expressed a desire to reduce the self-criticism and perfectionism that often underlie ED: \u0026ldquo;\u003cem\u003eI want a life that is not controlled by food, the freedom not to lose my mind if I have to change plans\u003c/em\u003e.\u0026rdquo; (P71).\u003c/p\u003e\u003cp\u003e\u003cem\u003eMain theme 3: External motivation\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe third main theme emerges from the statements of participants for whom the importance of change is not related to their own internal aspects, but rather to external factors and/or interpersonal relationships.\u003c/p\u003e\u003cp\u003eOne of the main motivations for change reported by these participants relates to the desire to no longer be perceived as worrying about their health by their caregivers (parents and/or partners), thus allowing them a greater psychological well-being. \u0026ldquo;\u003cem\u003eI want to make my family happy, without destroying myself and hurting them all the time\u003c/em\u003e.\u0026rdquo; (P22)\u003c/p\u003e\u003cp\u003eConsequently, the desire to have more functional relationships and to improve the ability to care for loved ones (such as potential partners and/or children) was also identified as a key motivator for change. \u0026ldquo;\u003cem\u003eI would like to be able to start a family and have a child without fear of harming them\u003c/em\u003e\u0026rdquo; (P97).\u003c/p\u003e\u003cp\u003eFinally, the possibility of achieving professional fulfilment without being hindered by the eating disorder is also identified by some participants as an important factor for change: \"\u003cem\u003eI want to be able to finish my medical studies and become a good doctor\u003c/em\u003e\u0026rdquo; (P188).\u003c/p\u003e\u003cp\u003e\u003cb\u003eCluster 2: Low ability to change\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe second open-ended question explored the motivations behind participants' confidence in their ability to recover from ED. Of the 205 participants who responded to this question, 98 expressed low confidence in their ability to change (replies\u0026thinsp;\u0026lt;\u0026thinsp;5 on a 1\u0026ndash;10 Likert scale) and formed the second cluster. Based on the motivations given by the participants for their low perception of ability to change, two main themes emerged: (4) negative self-beliefs and (5) ED characteristics.\u003c/p\u003e\u003cp\u003e\u003cem\u003eMain theme 4: Negative self-beliefs\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe fourth main theme illustrates the responses of participants who feel unable to recover from an eating disorder because they believe they lack the essential psychological skills, qualities and characteristics to engage in the recovery process. In particular, some participants stated that they were unable to see themselves as individuals capable of achieving psychological well-being, while others expressed a lack of self-efficacy, feeling too weak and easily demoralized. These beliefs lead to a self-image of being unable to change. \u0026ldquo;\u003cem\u003eAlthough I want to live a normal life, I think I am too weak to really change things\u003c/em\u003e\u0026rdquo; (P69).\u003c/p\u003e\u003cp\u003eFurthermore, many participants expressed the belief that eating disorders are a condition from which complete recovery is impossible, requiring lifelong management and constant fear of relapse. This belief is one of the main motivations identified as contributing to the perceived low ability to change. \u0026ldquo;\u003cem\u003eI have improved a lot so far, but I don't think I can improve any more. I will always be afraid of relapsing at any moment\u003c/em\u003e\u0026rdquo; (P14).\u003c/p\u003e\u003cp\u003e\u003cem\u003eMain theme 5: ED Characteristics\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe fifth main theme includes participants' statements suggesting that their low capacity for change is closely related to characteristics typical of eating disorders.\u003c/p\u003e\u003cp\u003eAmbivalence towards the eating disorder was reported by the majority of participants, who stated that they were not ready to fully recover from the eating disorder, which is seen as a comfort zone\u0026mdash;a well-known mechanism they fear leaving. \u0026ldquo;\u003cem\u003eI am afraid of change. Bulimia is both a great enemy and a certainty. Letting go of a certainty for uncertainty is a distressing situation for someone who is a control freak\u003c/em\u003e\u0026rdquo; (P138).\u003c/p\u003e\u003cp\u003eSimilarly, many participants stated that they did not perceive themselves as being able to change because of their personal history of relapse despite treatment, which led them to this belief. \u0026ldquo;\u003cem\u003eBecause I have often believed that I have recovered, only to relapse each time. It's like being in an endless tunnel\u003c/em\u003e\u0026rdquo; (P72).\u003c/p\u003e\u003cp\u003e\u003cb\u003eClusters 3: High ability to change\u003c/b\u003e\u003c/p\u003e\u003cp\u003e107 participants reported moderate to high confidence in their ability to change (responses\u0026thinsp;\u0026gt;\u0026thinsp;5 on a Likert scale of 1 to 10) and formed the third cluster. Based on the responses of these participants, two main themes emerged as influencing the perceived level of ability to change: (6) internal resources and (7) external resources.\u003c/p\u003e\u003cp\u003e\u003cem\u003eMain theme 6: Internal resources\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe sixth main theme relates to participants' statements suggesting that the high perceived ability to change is determined by strong self-confidence and belief in one\u0026rsquo;s own abilities and psychological skills, which enable them to engage effectively in the recovery process. \u0026ldquo;\u003cem\u003eI believe in myself and I know I can get better again because it is something I really want, and I know I deserve it\u003c/em\u003e\u0026rdquo; (P56).\u003c/p\u003e\u003cp\u003eFurthermore, many participants stated that they relied on their own determination to achieve what they had set out to do, such as recovering from eating disorders. \u0026ldquo;\u003cem\u003eI have overcome many challenges in my life and I am determined to fight and overcome my eating disorder\u003c/em\u003e\u0026rdquo; (P9).\u003c/p\u003e\u003cp\u003e\u003cem\u003eMain theme 7: External resources\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe final main theme consists of responses from participants who perceive a high capacity for change as facilitated by the presence of external resources. In particular, this theme includes statements about the importance of and trust in mental health professionals, who are seen as able to effectively support the patient during treatment and as a reliable resource to rely on. \u0026ldquo;\u003cem\u003eI have a strong desire to change, and I believe that with the help of a psychologist I could do it\u003c/em\u003e\u0026rdquo; (P135).\u003c/p\u003e\u003cp\u003eIn addition to health professionals, another important form of support is found in social relationships, including family members, partners, and friends, who, according to some participants, can help facilitate the change process. \u0026ldquo;\u003cem\u003eI know I have the support of my parents, who have always been there for me and believe in me\u003c/em\u003e\u0026rdquo; (P79).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics of the sample (N\u0026thinsp;=\u0026thinsp;205).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTitle 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23.14 (5.846)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20.941 (4.857)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e137 (66.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePart-time employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18 (8.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFull-time employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27 (13.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (4.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (6.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHousehold composition\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (6.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e144 (70.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27 (13.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRoommates/Friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (6.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSelf-reported diagnosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnorexia Nervosa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e96 (46.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBulimia Nervosa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27 (13.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBinge-eating disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34 (16.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther ED\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48 (23.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of illness (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.481 (3.927)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEDE-Q Restraint\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.792 (1.737)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEDE-Q Eating Concern\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.752 (1.404)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEDE-Q Shape Concern\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.892 (1.277)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEDE-Q Weight Concern\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.538 (1.407)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEDE-Q Total Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.243 (1.291)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDASS-21 Stress\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.61 (5.062)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDASS-21 Anxiety\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.58 (5.964)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDASS-21 Depression\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13.52 (5.998)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBAS-2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18.78 (7.540)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMR Importance to change\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.069 (2.536)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMR Ability to change\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.396 (2.301)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote: EDE\u0026minus;Q: Eating Disorder Examination\u0026minus;Questionnaire. DASS\u0026minus;21: Depression, Anxiety and Stress Scale. BAS\u0026minus;2: Body Appreciation Scale\u0026minus;2. MR: Motivational Ruler\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults of thematic analysis of users\u0026rsquo; answers of the two open-ended questions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClusters\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMain themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSub-themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExample\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eImportance to change (N\u0026thinsp;=\u0026thinsp;205)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional needs\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePsychological well-being\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWanting to start living again and be as happy as I was before ED\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAvoidance of negative thoughts and emotions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI can no longer live like this. I want to stop feeling like a complete failure.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAchievement of future planning goals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBecause I have understood that there is more to life than the disease. I want to recover so that I can set new goals, have a family and achieve personal fulfilment.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eManagement of illness maintenance factors\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFood anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI am tired and exhausted of this life focused only on the eating disorder, I am tired of thinking only about eating and compensating and having anxiety about all the features related to food.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBody acceptance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWearing the clothes I want without worrying about my weight.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSelf-criticism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI want to live without thinking that everything I do is wrong and that I am incapable of doing anything.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExternal motivation\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConcern for family carers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo stop worrying my family and hearing that I cause them pain.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImprove relationships\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo be more relaxed about dating and meeting new people without being afraid to show this side of me.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOvercoming difficulties at work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI have to be a trustworthy adult, especially in relation to my job. I'm a teacher, I can't show my pupils that I'm ill and have a difficult relationship with food.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eLow ability to change\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNegative self-beliefs (N\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInability to cope with change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThese changes are too big for me, and I am quickly demoralized by the awareness of the size of this obstacle, because I know that I am too vulnerable.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImpossibility of full recovery from EDs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI can never say I'm fully recovered, at the best I\u0026rsquo;m coping better, but I know the triggers will always be there to activate me for the rest of my life.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEDs characteristics \u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAmbivalence toward the change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI think I have the ability to change, but I can't really get into a perspective of real change for fear of getting out of a kind of \"comfort zone\" of situations related to my ED that are now an important part of my life.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHistory of ED relapse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBecause I've tried so many times and when I thought I was out of it, I always failed. Now I am sure that I can never change this situation.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eHigh ability to change (N\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal resources \u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConfidence in own psychological abilities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI believe in myself all the way through to this day and I know I can win this battle too.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDetermination to achieve set goals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI know that when I set a goal, I will do my best to achieve it, even if it takes a lot of time and efforts.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExternal resources\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePsychological therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI trust that if I start a psychological therapy I will be able to fully recover from EDs.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI am surrounded by people who love me and encourage me to change, and I know I can lean on them if I need to, so I think I can do it.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study aimed to explore the motivational landscape of individuals with self-reported eating disorder. By analyzing data from users who have engaged with an Instagram recovery community, this research focused on an increasingly visible yet understudied population: individuals who seek help outside traditional clinical settings.\u003c/p\u003e\u003cp\u003eThe results of the thematic analysis explored individual\u0026rsquo;s perceptions of the importance to change and identified a range of motivational sources. Emotional needs (e.g., desire for peace, hope, and self-acceptance), illness management goals (e.g., managing anxiety, reducing food-related distress), and external motivations (e.g., concern for loved ones or professional aspirations) emerged as key drivers of change. This spectrum seems to mirror findings from qualitative work by Venturo-Conerly et al. [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], who highlighted how motivation is often shaped by the interplay of personal suffering, future visioning, and relational dynamics. Our findings are also consistent with the Self-Determination Theory, which posits a motivational continuum ranging from behaviors that are externally motivated to behaviors that are internally motivated [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Our findings support the importance of cultivating both internal (e.g., emotional needs) and external motivations (e.g., relationship with family members) to promote individual\u0026rsquo;s change in eating disorders. The recent review by Robinson et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] showed that both illness perception (i.e. the negative impact of an ED) and relationship with others, including friends, family and parents, are associated with motivation to change in EDs.\u003c/p\u003e\u003cp\u003eGiven the importance to address the lack of motivation as a prominent barrier affecting engagement with treatment [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the current study explored how the perceived \u003cem\u003eability\u003c/em\u003e to change\u0026mdash;distinct from its \u003cem\u003eimportance\u003c/em\u003e\u0026mdash;varied across people with ED. Specifically, participants with low confidence often reported entrenched negative self-beliefs, repeated relapses, or emotional dependency on the ED symptoms as barriers to treatment. On the contrary, individuals with high confidence reported stronger internal determination and access to supportive relationships\u0026mdash;factors long associated with positive treatment trajectories [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFrom a clinical perspective, these findings underscore the necessity of early-stage, flexible interventions that validate ambivalence while gradually improving their confidence and enhancing readiness to change [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. On the other hand, therapists who work with patients with eating disorders should prioritize the establishment of a warm and bonding therapeutic relationship to foster the main illness maintenance factors [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. In these clinical setting therapists\u0026rsquo; personal characteristics, such as empathic, supportive attitudes, authenticity and the tendency to self-disclose, need to be preserved as an important predictor on therapy outcome and the quality of the therapeutic relationship [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Interventions such as Motivational Interviewing [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and Motivational Enhancement Therapy can be particularly useful in this regard, especially when adapted to the individual's stage of change [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Moreover, the findings confirm the importance of addressing eating disorders more broadly\u0026mdash;including subthreshold and atypical presentations\u0026mdash;which are often overlooked in research and services, despite being associated with significant impairment and risk of chronicity [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA major contribution of this study is its focus on help-seeking through social media platforms. Although there is research evidence that appearance-related social media use may trigger dysfunctional eating behaviors by perpetuating harmful idealized body ideals [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], they can also be used as a tool to assist in recovery [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. For example, online recovery communities can offer positive support for people with eating disorders by providing safe spaces for discussion and peer support [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In the current study, we surveyed participants from a Instagram online community\u0026mdash;run by professionals and structured to offer evidence-based psychoeducation and peer modeling and strengthen motivation [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Although some recent research has explored the ED recovery content and post created in social media such as Instagram and TiKTok [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], the current study is the first to explore users\u0026rsquo; view of their motivation to change. In light of these findings, it is crucial to emphasize the clinical importance of facilitating early access to specialized services for individuals with EDs. Although online recovery communities can provide valuable motivational support, formal clinical interventions remain essential to address the underlying maintenance factors of EDs and to foster self-efficacy in change processes [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Timely access to specialized treatment is associated with improved outcomes and reduced chronicity [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Therefore, integrating digital psychoeducation via social media with accessible pathways to professional care may be a promising strategy to bridge the treatment gap and improve recovery trajectories [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTaken together, our findings highlighted the complexity of social media users\u0026rsquo; ambivalence towards recovery. Consistent with previous evidence [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], in the current study many participants expressed a simultaneous desire for change and an attachment to the disorder. This tension\u0026mdash;seen across diagnostic groups\u0026mdash;was particularly evident in those with AN, for whom ED may serve identity-affirming functions. However, similar patterns also emerged in individuals with BN and BED, particularly in relation to emotional regulation and body dissatisfaction. These dynamics are in line with the cognitive-interpersonal maintenance model [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e], which emphasizes the role of both individual traits (e.g., perfectionism, rigidity, impulsivity) and interpersonal factors in maintaining disordered eating behaviors.\u003c/p\u003e\u003cp\u003eHowever, social media recovery community can be helpful to address participants\u0026rsquo; ambivalence to change. The potential of the online community to bridge the gap between illness onset and treatment is particularly relevant. Delays in accessing care are common and associated with worse outcomes [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], yet online resources may offer psychoeducational scaffolding and motivational support during this waiting period.\u003c/p\u003e\u003cp\u003eThese online platforms may also provide a safe and familiar space for those who do not meet full diagnostic criteria but still experience clinically significant disordered eating. In line with stepped-care models, digital interventions could function as early-stage tools, offering psychoeducation and motivational support that prepare individuals for formal treatment when they are ready, while simultaneously reducing stigma and enhancing health literacy [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral strengths characterize this study. First, it captures a real-world, underrepresented population that engages in non-traditional help-seeking, thus offering ecological validity. Second, the use of a widely accessible platform like Instagram increases the generalizability of findings to current digital behavior patterns, especially among younger demographics.\u003c/p\u003e\u003cp\u003eNevertheless, some limitations must be acknowledged. The sample was composed exclusively of self-identified female participants, limiting the generalizability to other genders. The reliance on self-report data and non-verified diagnoses introduces potential biases. Additionally, because participants were already motivated enough to seek information online, the sample may not capture individuals in the earliest (precontemplation) stage of change. The use of qualitative analysis, which, while providing rich and in-depth insights, may be subject to researcher bias and limited generalizability to different clinical populations. Finally, the cross-sectional design prevents any causal inference regarding motivation and help-seeking behaviors.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis study highlights the promise of integrating social media\u0026ndash;based psychoeducational strategies into early intervention frameworks for EDs. Digital profiles on Instragram such as #\u003cem\u003eDicci come aiutarti\u003c/em\u003e can serve not only to disseminate recovery-oriented content, but also to identify at-risk individuals, offer emotional validation, and encourage formal help-seeking. These platforms could be leveraged to assess readiness for change in real time and provide tailored content according to motivational stage\u0026mdash;potentially using tools like interactive polls, direct messaging, or adaptive story formats.\u003c/p\u003e\u003cp\u003eFuture research should investigate the longitudinal impact of digital interventions on motivation, treatment initiation, and symptom change. It would also be important to explore male and non-binary experiences with similar help-seeking behaviors and to examine the potential for social media\u0026ndash;based interventions to complement therapist-guided approaches in hybrid care models.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eThe following abbreviations are used in this manuscript:\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eED/EDs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEating Disorder/Eating Disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAnorexia Nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBulimia Nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBinge Eating Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCBT-E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEnhanced Cognitive Behaviour Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMotivational Interviewing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMotivational Enhancement Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInstagram\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody Mass Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEDE-Q\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEating Disorder Examination Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDASS-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDepression, Anxiety and Stress Scale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBAS-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody Appreciation Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eThe authors declare that this proposal was con-ducted in the absence of any commercial or financial relationships that could be construed as po-tential conflicts of interest.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\u003cp\u003e The study was conducted in accordance with the Dec-laration of Helsinki. Ethical review and approval were waived for this study due to its prelimi-nary nature. Informed Consent Statement: Informed consent was obtained from all subjects in-volved in the study.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe study is funded by the Italian Ministry of University and Research as part of a na-tional grant (PRIN 2022 PNRR), Prot. P202237PFB (Finanziato dall'Unione Europea \u0026ndash; Next Gen-eration EU\u0026rdquo;).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, G.A., A.T., G.L.C., S.G.; methodology, G.A., A.T., G.L.C., S.G; software, G.A.; validation, G.A., A.T., G.L.C., S.G; formal analysis, G.A., A.T.; investi-gation, G.A., G.L.C. ; resources, G.A., A.T., G.L.C., S.G; data curation, G.A., A.T.; writing\u0026mdash;original draft preparation, G.A., G.L.C., A.T. and S.G.; writing\u0026mdash;review and editing, G.A., G.L.C., A.T. and S.G.; visualization, G.A and A.T.; supervision, G.A., G.L.C. and S.G.; project administration, G.A., and S.G.; funding acquisition, G.A., A.T. All authors have read and agreed to the published ver-sion of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe are grateful to the recovered individuals, actually content creators, who contributed to the development of the contents offered through the #Dicci Come Aiutarti IG profile. We acknowledge the support of psychology students and external volunteers across Italy that with passion and enthusiasm worked hard to the dissemination of our contents on a weekly basis.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe dataset generated for this study is available on request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Text revision. Washington (DC): American Psychiatric Publishing; 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAttia E, Walsh BT. Eating disorders: a review. JAMA. 2025;333:1242\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2025.0132\u003c/span\u003e\u003cspan address=\"10.1001/jama.2025.0132\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTreasure J, Duarte TA, Schmidt U. Eating disorders. Lancet. 2020;395:899\u0026ndash;911. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(20)30059-3\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(20)30059-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHilbert A, Hoek HW, Schmidt R. Evidence-based clinical guidelines for eating disorders: International comparison. Curr Opin Psychiatry. 2017;30:423\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/YCO.0000000000000360\u003c/span\u003e\u003cspan address=\"10.1097/YCO.0000000000000360\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMonteleone AM, Pellegrino F, Croatto G, et al. Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses. Neurosci Biobehav Rev. 2022;142:104857. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.neubiorev.2022.104857\u003c/span\u003e\u003cspan address=\"10.1016/j.neubiorev.2022.104857\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRussell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: Findings from a rapid review. J Eat Disord. 2023;11:175. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40337-023-00886-w\u003c/span\u003e\u003cspan address=\"10.1186/s40337-023-00886-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDalle Grave R, Calugi S, Sartirana M, Fairburn CG. Enhanced cognitive behavior therapy for eating disorders: A transdiagnostic treatment. New York (NY): Guilford Press; 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDalle Grave R, Sartirana M, Dalle Grave A, Calugi S. Effectiveness of enhanced cognitive behaviour therapy for patients aged 14 to 25: A promising treatment for anorexia nervosa in transition-age youth. Eur Eat Disord Rev. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/erv.3019\u003c/span\u003e\u003cspan address=\"10.1002/erv.3019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobinson L, Flynn M, Cooper M. Individual differences in motivation to change in individuals with eating disorders: A systematic review. Int J Eat Disord. 2024;57:1069\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/eat.24178\u003c/span\u003e\u003cspan address=\"10.1002/eat.24178\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCooper Z, Bailey-Straebler S, McClelland J. Motivational interviewing for eating disorders. In: Miller WR, Rollnick S, editors. Motivational interviewing: Helping people change. 3rd ed. New York (NY): Guilford Press; 2016. pp. 536\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTreasure J, Schmidt U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord. 2013;1:13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/2050-2974-1-13\u003c/span\u003e\u003cspan address=\"10.1186/2050-2974-1-13\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAloi M, Rania M, Lo Coco G, Carcione A, Castellini G, Waldherr K, et al. Editorial: Psychosocial risk factors in the development, maintenance and treatment outcome of eating disorders. Front Psychol. 2024;15:1486941. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyg.2024.1486941\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2024.1486941\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClausen L, L\u0026uuml;beck M, Jones A. Motivation to change in the eating disorders: a systematic review. Int J Eat Disord. 2013;46:755\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/eat.22156\u003c/span\u003e\u003cspan address=\"10.1002/eat.22156\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSansfa\u0026ccedil;on J, Booij L, Gauvin L, Fletcher E, Islam F, Israel M, et al. Pretreatment motivation and therapy outcomes in eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2020;53:1879\u0026ndash;900. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/eat.23376\u003c/span\u003e\u003cspan address=\"10.1002/eat.23376\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a 'transdiagnostic' theory and treatment. Behav Res Ther. 2003;41:509\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0005-7967(02)00088-8\u003c/span\u003e\u003cspan address=\"10.1016/S0005-7967(02)00088-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCardi V, Albano G, Ambwani S, et al. A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa. Psychol Med. 2020;50(15):2610\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/S0033291719002824\u003c/span\u003e\u003cspan address=\"10.1017/S0033291719002824\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eProchaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/0022-006X.51.3.390\u003c/span\u003e\u003cspan address=\"10.1037/0022-006X.51.3.390\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eProchaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12:38\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4278/0890-1171-12.1.38\u003c/span\u003e\u003cspan address=\"10.4278/0890-1171-12.1.38\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTreasure J, Willmott D, Ambwani S, Cardi V, Clark Bryan D, Rowlands K, et al. Cognitive interpersonal model for anorexia nervosa revisited: the perpetuating factors that contribute to the development of the severe and enduring illness. J Clin Med. 2020;9:630. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm9030630\u003c/span\u003e\u003cspan address=\"10.3390/jcm9030630\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIyar MM, Cox DW, Kealy D, Srikameswaran S, Geller J. Is stage of change enough? Confidence as a predictor of outcome in inpatient treatment for eating disorders. Int J Eat Disord. 2019;52:283\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/eat.23026\u003c/span\u003e\u003cspan address=\"10.1002/eat.23026\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2015;48:946\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/eat.22411\u003c/span\u003e\u003cspan address=\"10.1002/eat.22411\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLinardon J, Messer M, Lee S, Andrew E. Individual differences in motivation to change and eating disorder psychopathology: a systematic review and meta-analysis. Int J Eat Disord. 2022;55:295\u0026ndash;309. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/eat.23698\u003c/span\u003e\u003cspan address=\"10.1002/eat.23698\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDenison-Day J, Muir S, Newell C, Bennett SD. Motivational interventions in eating disorders: a systematic review and meta-analysis. Clin Psychol Rev. 2018;62:1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.cpr.2018.05.005\u003c/span\u003e\u003cspan address=\"10.1016/j.cpr.2018.05.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFitzsimmons-Craft EE, Balantekin KN, Graham AK, Smolar L, Park D, Mysko C, et al. Results of disseminating an online screen for eating disorders across the U.S.: reach, respondent characteristics, and unmet treatment need. Int J Eat Disord. 2019;52:721\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/eat.23043\u003c/span\u003e\u003cspan address=\"10.1002/eat.23043\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAli K, Farrer L, Fassnacht DB, Gulliver A, Bauer S, Griffiths KM. Perceived barriers and facilitators towards help-seeking for eating disorders: a systematic review. Int J Eat Disord. 2017;50:9\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/eat.22598\u003c/span\u003e\u003cspan address=\"10.1002/eat.22598\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGriffiths S, Rossell SL, Mitchison D, Murray SB, Mond JM. Pathways into treatment for eating disorders: a quantitative examination of treatment barriers and treatment attitudes. Eat Disord. 2018;26:556\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/10640266.2018.1518086\u003c/span\u003e\u003cspan address=\"10.1080/10640266.2018.1518086\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHart LM, Granillo MT, Jorm AF, Paxton SJ. Unmet need for treatment in the eating disorders: a systematic review of eating disorder-specific treatment seeking among community cases. Clin Psychol Rev. 2011;31:727\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.cpr.2011.03.004\u003c/span\u003e\u003cspan address=\"10.1016/j.cpr.2011.03.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDaugelat MC, Pruccoli J, Schag K, Giel KE. Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: a systematic review synthesising patient, caregiver and clinician perspectives. Eur Eat Disord Rev. 2023;31:752\u0026ndash;68. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/erv.2999\u003c/span\u003e\u003cspan address=\"10.1002/erv.2999\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHolland G, Tiggemann M. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image. 2016;17:100\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bodyim.2016.02.008\u003c/span\u003e\u003cspan address=\"10.1016/j.bodyim.2016.02.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSharpe H, Vidal CA. Scoping literature review of the associations between highly visual social media use and eating disorders and disordered eating: a changing landscape. J Eat Disord. 2023;11:170. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40337-023-00898-6\u003c/span\u003e\u003cspan address=\"10.1186/s40337-023-00898-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodgers RF, Melioli T, Laconi S, Bui E, Chabrol H. Internet addiction symptoms, disordered eating, and body image avoidance. Cyberpsychol Behav Soc Netw. 2013;16:56\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/cyber.2012.1570\u003c/span\u003e\u003cspan address=\"10.1089/cyber.2012.1570\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGing D, Garvey S. Written in these scars are the stories I can't explain\u0026rsquo;: a content analysis of pro-ana and thinspiration image sharing on Instagram. New Media Soc. 2018;20:1181\u0026ndash;200. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1461444816687288\u003c/span\u003e\u003cspan address=\"10.1177/1461444816687288\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAu ES, Cosh SM. Social media and eating disorder recovery: an exploration of Instagram recovery community users and their reasons for engagement. Eat Behav. 2022;46:101651. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.eatbeh.2022.101651\u003c/span\u003e\u003cspan address=\"10.1016/j.eatbeh.2022.101651\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHerrick SSC, Hallward L, Duncan LR. This is just how I cope': an inductive thematic analysis of eating disorder recovery content created and shared on TikTok using #EDrecovery. Int J Eat Disord. 2021;54:516\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBohrer BK, Foye U, Jewell T. Recovery as a process: exploring definitions of recovery in the context of eating-disorder-related social media forums. Int J Eat Disord. 2020;53:1219\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoh AQY, Lo NYW, Davis C, et al. #EatingDisorderRecovery: a qualitative content analysis of eating disorder recovery-related posts on Instagram. Eat Weight Disord. 2022;27:1535\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40519-021-01279-1\u003c/span\u003e\u003cspan address=\"10.1007/s40519-021-01279-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKenny TE, Boyle SL, Lewis SP. #recovery: understanding recovery from the lens of recovery-focused blogs posted by individuals with lived experience. Int J Eat Disord. 2019;53:1234\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/eat.23221\u003c/span\u003e\u003cspan address=\"10.1002/eat.23221\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlbano G, Lo Coco G, Teti A, Semola M, Valenti F, Pastizzaro CD, et al. #How can we help you? an Instagram-based online self-help for eating disorders. Sustainability. 2023;15:2389. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/su15032389\u003c/span\u003e\u003cspan address=\"10.3390/su15032389\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord. 1994;16:363\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCalugi S, Milanese C, Sartirana M, El Ghoch M, Sartori F, Geccherle E, et al. The Eating Disorder Examination Questionnaire: reliability and validity of the Italian version. Eat Weight Disord. 2017;22:509\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40519-016-0276-6\u003c/span\u003e\u003cspan address=\"10.1007/s40519-016-0276-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33:335\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0005-7967(94)00075-U\u003c/span\u003e\u003cspan address=\"10.1016/0005-7967(94)00075-U\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBottesi G, Ghisi M, Alto\u0026egrave; G, Conforti E, Melli G, Sica C. The Italian version of the Depression Anxiety Stress Scales-21: factor structure and psychometric properties on community and clinical samples. Compr Psychiatry. 2015;60:170\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTylka TL, Wood-Barcalow NL. The Body Appreciation Scale-2: item refinement and psychometric evaluation. Body Image. 2015;12:53\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCasale S, Prostamo A, Giovannetti S, Fioravanti G. Translation and validation of an Italian version of the Body Appreciation Scale-2. Body Image. 2021;37:1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1191/1478088706qp063oa\u003c/span\u003e\u003cspan address=\"10.1191/1478088706qp063oa\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHill CE. Consensual qualitative research (CQR): methods for conducting psychotherapy research. In: Gelo OCG, Pritz A, Rieken B, editors. Psychotherapy research: Foundations, process, and outcome. Vienna (Austria): Springer; 2015. pp. 485\u0026ndash;99. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/978-3-7091-1382-0_23\u003c/span\u003e\u003cspan address=\"10.1007/978-3-7091-1382-0_23\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVenturo-Conerly KE, Wasil AR, Shingleton RM, Weisz JR. A qualitative investigation of factors promoting motivation for eating disorder recovery. Int J Eat Disord. 2020;53:554\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/eat.23246\u003c/span\u003e\u003cspan address=\"10.1002/eat.23246\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRyan RM, Deci EL. Self-determination theory: basic psychological needs in motivation, development, and wellness. New York (NY): Guilford Press; 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSteiger H. Evidence-informed practices in the real-world treatment of people with eating disorders. Eat Disord. 2017;25:173\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/10640266.2016.1269558\u003c/span\u003e\u003cspan address=\"10.1080/10640266.2016.1269558\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlbano G, Teti A, Scr\u0026ograve; A, Bonfanti RC, Fortunato L, Lo Coco G. A systematic review on the role of therapist characteristics in the treatment of eating disorders. Res Psychother. 2024;27(2):750. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4081/ripppo.2024.750\u003c/span\u003e\u003cspan address=\"10.4081/ripppo.2024.750\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBonfanti RC, Teti A, Albano G, Melchiori F, Raffard S, Rodgers R, et al. The association between social comparison in social media, body image concerns and eating disorder symptoms: a systematic review and meta-analysis. Body Image. 2025;52:101841. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bodyim.2024.101841\u003c/span\u003e\u003cspan address=\"10.1016/j.bodyim.2024.101841\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVitousek K, Watson S, Wilson GT. Enhancing motivation for change in treatment-resistant eating disorders. Clin Psychol Rev. 1998;18:391\u0026ndash;420. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0272-7358(98)00012-9\u003c/span\u003e\u003cspan address=\"10.1016/S0272-7358(98)00012-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlbano G, Rowlands K, Baciadonna L, Lo Coco GL, Cardi V. Interpersonal difficulties in obesity: a systematic review and meta-analysis to inform a rejection sensitivity-based model. Neurosci Biobehav Rev. 2019;107:846\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.neubiorev.2019.09.039\u003c/span\u003e\u003cspan address=\"10.1016/j.neubiorev.2019.09.039\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHolmberg C, Berg C, Dahlgren J, Lissner L, Chaplin JE. Health literacy in a complex digital media landscape: pediatric obesity patients\u0026rsquo; experiences with online weight, food, and health information. Health Inf J. 2018;24:202\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1460458216663023\u003c/span\u003e\u003cspan address=\"10.1177/1460458216663023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"eating disorders, motivation to change, thematic analysis, help-seeking, ability to change, social media, Instagram","lastPublishedDoi":"10.21203/rs.3.rs-6956741/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6956741/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground:\u003c/em\u003eTreatment engagement and motivation to change remain significant challenges that impact treatment delivery in people with eating disorders. Feelings of shame, stigma, ambivalence and lack of motivation are prominent barriers affecting their engagement with treatment. There is recent evidence that using online recovery communities is beneficial in reaching individuals who do not have access to traditional services. The present study has been designed to investigate the perceived significance and level of confidence regarding change exhibited by individuals suffering from an eating disorder who are active participants in a recovery Instagram community.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods:\u003c/em\u003e A mixed methods study surveyed 205 women (mean age = 23.14 years) from an Instragram recovery community. Thematic qualitative analysis was used to evaluate themes reported in response to open-ended questions about participants’ meaning and confidence to change.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults:\u003c/em\u003eParticipants reported higher scores for motivation to change than for ability to change. Seven themes were interpreted from the qualitative data (i.e. Emotional Needs, Management illness factors, External Motivation, Negative Sel-beliefs, Internal and External Resources, and Characteristics of eating disorders).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusions:\u003c/em\u003e The results of this study highlight that although participants report the importance of change, there are some concerns about their ability to change, related to their negative self-beliefs and ambivalence about change. The findings also suggest that Instragram recovery communities are promising platforms for improving help-seeking among users with eating disorders.\u003c/p\u003e","manuscriptTitle":"Navigating an Instagram Community for Eating Disorder Recovery: A Qualitative Study of Users' Motivation and Confidence to Change","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-10 12:37:23","doi":"10.21203/rs.3.rs-6956741/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-18T14:46:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T13:34:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-16T10:52:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-05T14:36:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"57700063913841492726907700113032820690","date":"2025-07-18T10:31:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283216519404704263738627156824353978873","date":"2025-07-17T08:41:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253996316065604085745322697377122185861","date":"2025-07-11T17:23:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283351540170197335101712355174955726035","date":"2025-07-08T19:35:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-08T14:43:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-03T11:32:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-02T03:37:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-02T03:36:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-06-23T12:14:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"080f6fdc-e346-46e3-a5d7-b686674ed8bd","owner":[],"postedDate":"July 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T16:11:40+00:00","versionOfRecord":{"articleIdentity":"rs-6956741","link":"https://doi.org/10.1186/s12888-025-07591-9","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2025-11-14 15:57:13","publishedOnDateReadable":"November 14th, 2025"},"versionCreatedAt":"2025-07-10 12:37:23","video":"","vorDoi":"10.1186/s12888-025-07591-9","vorDoiUrl":"https://doi.org/10.1186/s12888-025-07591-9","workflowStages":[]},"version":"v1","identity":"rs-6956741","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6956741","identity":"rs-6956741","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}