‘Falling down the rabbit hole’: a thematic analysis of young people’s views on TikTok algorithms and eating disorder content

‘Falling down the rabbit hole’: a thematic analysis of young people’s views on TikTok algorithms and eating disorder content | 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 ‘Falling down the rabbit hole’: a thematic analysis of young people’s views on TikTok algorithms and eating disorder content Tamsin Parnell, Daniel Hunt, Jessica Wilkins, Başak İnce, Schmidt Ulrike, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7283049/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Dec, 2025 Read the published version in Journal of Eating Disorders → Version 1 posted 9 You are reading this latest preprint version Abstract Background TikTok’s algorithm is at the centre of its user experience. The platform, which allows users to create and consume short-form content, can enable young people (YP) to feel less alone when experiencing illnesses such as eating disorders (EDs) by encouraging them to build communities around mental health-related content. However, emerging research suggests TikTok’s algorithm might exacerbate ED symptoms by leading YP into spirals of ED content. This paper provides a lived experience perspective on what experiencing high volumes of ED content on TikTok’s For You Page (FYP) can be like for YP. Methods We conducted 17 semi-structured interviews in which participants (UK-based, aged 16-25, with experience of disordered eating or an ED) described their experiences of using TikTok. We identified three themes that express how participants interact with ED content on TikTok: (1) View One, See More, (2) Morbid Curiosity, and (3) From Helpful to Unhelpful. Theme 1 describes viewing one unhelpful video and then being exposed to more of this content on the FYP. Theme 2 refers to young people’s descriptions of a strong impulse to view ED content when it surfaces on their FYP even if it is felt to be unhelpful. Theme 3 recounts young people’s experiences of viewing potentially helpful content (e.g., pro-recovery videos) and then being presented with pro-ED content on the FYP. Through a close linguistic analysis, we examine how participants talk about how they feel when viewing ED content on TikTok. Findings Participants reported engaging regularly with ED content on TikTok. Their interactions with ED content show that the personalised nature of TikTok’s algorithm (which is sensitised to how long a user watches a video) can interact with and exacerbate some ED behaviours and psychologies, leading some YP into negative echo-chambers of ED content. Conclusion Platforms should assume greater responsibility for their algorithms’ roles in intensifying ED symptoms and improve the efficacy of functions that help users control the content they see. A greater awareness of the role of TikTok in exacerbating ED thoughts and behaviours among mental health professionals is also necessary. TikTok social media eating disorders algorithms ED content young people qualitative thematic analysis Plain English summary This study explored how young people with a current or past eating disorder (EDs) describe their experience of viewing ED content on the social media platform TikTok and how this affects their ED and recovery. We interviewed 17 UK-based young people (aged 16-25) with lived experience of an ED. Data showed that the personal experience with the TikTok algorithm – which shows curated content to each user through its ‘For You Page’ – can lead users into ‘negative spirals’ of ED content, increasingly flooding them with ED materials. This can affect, interact with and, in some cases, worsen ED-related thoughts and behaviours of the young people. Background Young people’s use of SM is ‘almost ubiquitous’ (Yang, Holden and Ariati, 2021: 631). SM allows young people to develop social connections (Radovic et al., 2017) and engage in civic and political life (Boulianne and Theocharis, 2018). It enables them to practise identity and relationship management strategies (Wang and Edwards, 2016) and can support elements of educational and cognitive development (Gray, 2018). However, Valkenburg, Meier and Beyens (2022) warn that SM also offers young people opportunities to engage in risky behaviours outside of parental oversight. As adolescence is a time when well-being shows the most fluctuations (Maciejewski et al., 2019) and risk-taking is at a peak (Steinberg, 2007), parents, policymakers and scholars seek to understand the effects of social media use (SMU) on youth mental health (Valkenburg, Meier and Beyens, 2022). This also includes more research into the addictive potential and psychological and behavioural impacts of the platform as highlighted by Caponnetto et al. (2025). The porous borders between helpful and unhelpful SM content are particularly salient for young people with EDs and their online engagement with ED-related content. Research into the role of the internet for those affected by EDs has established a positive impact with regards to community building (Greene et al., 2023, Greene and Norling, 2023, Lookingbill et al., 2023, Bartel and Downs, 2024), social support and validation (Au and Cosh, 2022) and reducing barriers to help-seeking (Kendal et al., 2015). However, studies have also identified harmful effects of online spaces for people with EDs. Numerous projects have analysed pro-ED websites (Rouleau and von Ranson, 2011; Peebles et al., 2012; Steakley-Freeman et al., 2015) and pro-ED accounts on SM sites such as Twitter/X (Arseniev-Koehler et al., 2016) and Instagram (Goh et al., 2022). These studies have recognised the fine line between helpful and unhelpful or even harmful content in which even spaces that are ostensibly pro-recovery can include unhelpful and potentially harmful content on diet culture, triggering imagery, and appearance. While previous studies have addressed the role of health forums or SM applications like Instagram in exacerbating ED symptoms, recent research has begun to consider ED and ED recovery content on TikTok (see, for example, Herrick et al., 2021; Griffiths et al., 2024). TikTok is an algorithm-driven application that, among other things, allows users to consume and create short-form video content (Herrick et al., 2021; McCashin and Murphy, 2023). The application has extensive global reach, is popular with young people, and sees high levels of engagement with mental health content (Greene et al., 2023). TikTok is therefore ‘emerging as a pivotal tool’ (Rejeb et al., 2024) for health information dissemination with attendant concerns about the quality of content and dis/misinformation (Eghtesadi & Florea, 2020; Zheng et al., 2021), as well as the potential to exacerbate ED symptoms (Griffiths et al., 2024; see below). Existing studies on TikTok and EDs have typically categorised the type of content found under disorder-specific hashtags, such as #anarecovery and #arfidrecovery (Greene et al., 2023) and general recovery hashtags, such as #EDrecovery (Herrick et al., 2021). At the time of writing (April 2025), the #EDrecovery tag is used in over 323,000 TikTok videos. Previous studies (e.g., Davis et al., 2023; Herrick et al., 2021) have identified the prevalence of a TikTok challenge called What I Eat In A Day (WIEIAD), which sees content creators document what they have consumed throughout the day, often in an ED recovery context. The genre of WIEIAD videos reflects the public mundanity of much social media content (e.g., Get Ready with Me videos, or GRWM), which focuses on “everyday-ness”. However, WIEIAD videos are given particular significance in the context of ED recovery because they can encourage comparison or promote unhealthy behaviours including rigid monitoring of food and exercise. For example, Davis et al. (2023) thematically categorised 100 videos posted to the hashtag #WhatIEatInADay, finding 15 videos in which creators discussed engagement in disordered eating behaviours such as misusing laxatives and skipping meals (2023). In addition to the What I Eat In A Day trend, Herrick et al. (2021) also identified that some users post weight gain “glow ups” under the hashtag #EDrecovery; in these posts, two contrasting pictures show a body at a very low weight and the same weight-restored body. What sets TikTok apart from other SM platforms is the centrality of its content selection algorithm, which determines what appears on each user’s For You Page (FYP, a page which shows personalised content to each user). In comparison to other SM platforms such as Instagram or X (formerly Twitter), TikTok places less emphasis on following and subscribing to accounts, leading to a much less explicit representation of the user’s network from which the content they see is drawn; instead, the algorithm directs the flow of content. In other words, although algorithms are used across a wide range of SM, TikTok is the only platform that puts the algorithm at the core of the social experience it offers its users (Bhandari et al., 2022). A recent study by Griffiths et al. (2024) indicates that TikTok’s algorithm may exacerbate eating disorder symptoms. Building on the work of a Wall Street Journal (2021) investigation into how TikTok’s algorithm works, the study suggests the algorithm is sensitised to how long a user watches a video for. This means that the longer someone watches a video, the more likely they are to see similar content on their FYP. In the context of EDs, Griffiths et al. imagine a scenario in which a young person engages with, instead of scrolling past, a video that they might find less helpful for their ED because it, among other things, intensifies anxiety or encourages them to compare their appearance unfavourably to another person. This longer view-time increases the likelihood that the user will be exposed by the algorithm to more of this unhelpful content on their FYP. In short, a vulnerable user could find themselves in a situation whereby they are repeatedly exposed to ED-related videos because the algorithm has identified this type of content as something with which the user engages, either actively or passively. As mental health professionals may have a limited understanding of the functionality of the TikTok algorithm and how it might exacerbate symptoms of mental illness (McCashin and Murphy 2023), it is necessary to develop research in this area that can enrich clinical understandings of how exposure to the TikTok algorithm can affect YP with EDs. Here, we offer lived experience findings that can illustrate how TikTok’s algorithm interacts with ED content to affect YP with EDs. In so doing, we respond to longstanding calls to understand the complexities of online health information beyond reductive concerns with information accuracy and to consider users’ consumptive practices and their nuanced effects (Nettleton, Burrows and O’Malley, 2005). Methods Recruitment and participants Ethical approval for this study was granted by the University of Nottingham (approval reference code: R2324/022). Two UK ED charities, Beat and First Steps, helped with recruitment via social media (X, Instagram, TikTok), on websites and in newsletters. Participants had to be aged between 16 and 25, live in the UK, have experienced an ED or disordered eating (with or without formal diagnosis), and have posted or viewed ED content on social media. In our recruitment material we highlighted that we would particularly like to hear from people currently underrepresented in ED narratives, including those who live rurally, identify as LGBTQ+, identify as ethnically or culturally diverse, and/or as experiencing resource insecurity. These lenses were chosen by young people as priorities as part of the EDIFY research project (LENS, n.d.; EDIFY, n.d.). Potential participants completed an expression of interest (EOI) form and in response were sent study information and consent forms. Once they had given their written informed consent, an online interview was organised, and the research questions were shared (see Appendix 1 for interview questions). In total, there were 67 responses to the EOI form with 30 participants responding to a follow-up email and consenting to an online interview, which was held via Microsoft Teams. After the interview, each participant received a £15 voucher. While the interviews focused on participants’ experiences of engaging with ED content on social media broadly, here we present data from 17 of these interviews in which participants spoke specifically about their TikTok use and its effects on them. Participants were not asked to disclose their specific type of disordered eating or ED, but as open questions encouraged them to share as much or as little as they felt comfortable sharing, many did disclose an ED diagnosis. All participants said that they used apps such as TikTok daily, although we did not ask about the time spent on social media. Table 1 presents the characteristics of the participants. Table 1: Participant characteristics Participant ID Gender Lens(es) Diagnosis disclosed 1 Female Living rurally Anorexia nervosa 3 Female LGBTQ+ Anorexia nervosa 6 Female Resource insecurity Disordered eating (self-diagnosis of orthorexia) 7 Female Living rurally Anorexia nervosa and bulimia 8 Female Cultural diversity Atypical anorexia and then anorexia nervosa 9 Female Resource insecurity Anorexia nervosa 10 Female Ethnic diversity Disordered eating 11 Female Living rurally Disordered eating 12 Female LGBTQ+ Disordered eating (self-diagnosis of bulimia) 15 Female LGBTQ+, resource insecurity Anorexia nervosa 16 Female LGBTQ+ Disordered eating 19 Female Does not identify with our lenses Anorexia (with bulimia) 20 Female Ethnic diversity Anorexia nervosa 21 Female LGBTQ+ Anorexia nervosa 22 Female LGBTQ+. Bulimia 23 Female Does not identify with our lenses Disordered eating 27 Female Does not identify with our lenses Anorexia nervosa Analytical process The analytical process we adopt in this project is thematic analysis (Braun and Clarke, 2006; Clarke and Braun, 2017). In line with Braun and Clarke (2006), we understand a theme to be a patterned response in our dataset that does not have to be the most quantitatively important pattern, but which contributes to an important aspect of meaning-making in the data. The data analysis process was inductive; we did not ask specific questions about TikTok algorithms and ED-related content during the interviews but rather found this was a prevalent topic across many of the interview responses and was therefore worthy of greater attention. TP transcribed the interviews from recordings. Three authors (TP, DH, HB) read the interview transcripts independently several times and identified codes and came together to discuss their findings and discovered overlaps, especially across the following codes: representations of agency, depictions of the algorithm as sentient or powerful, and consumption of ED content as compulsive. During these meetings these authors also reflected on their own experiences as social media users as well as our previous research with individuals with EDs and on online contexts and how these may have shaped their responses to the participants’ data. Together, through extensive discussion, the authors generated the three “key” higher-level themes that brought together these codes by reflecting how the participants described their interaction with a powerful algorithm and a compulsion to view ED content through the lens of (lack of) user agency. The authors then selected extracts that reflected each of the key themes most closely. All three authors analysed the extracts independently to identify key linguistic features of interest related to agency, disempowerment, and depictions of the algorithm. The authors then came together again to share their findings and agree on a mutual interpretation of each of the extracts that would lend itself to an overall argument. Results Throughout the interviews, there was one type of content that YP positioned as helpful on TikTok: images or videos of people with EDs having full and rich lives outside of their ED. Three types of content on TikTok were positioned by young people as “unhelpful” with regards to their disordered eating and ED. The “unhelpful” content was: (1) What I Eat In A Day challenges, (2) before and after pictures that visualised weight gain, and (3) gym and fitness content posted by ostensibly recovery-oriented accounts. Our thematic analysis delineated three dominant themes that account for participants’ encounters with this type of content, and which seek to capture both participants’ immediate experiences and the longer-term effects of consuming this content: ‘View One, See More’, ‘Morbid Curiosity’ and ‘From Helpful to Unhelpful’ Theme 1: View One, See More View One, See More, refers to a pattern in which participants describe watching a single video and then being consistently exposed to more of that content, making it hard to escape from. The emphasis in this theme is on users’ lack of control to stop the activities of the algorithm. During the interview, we asked participants how social media could be improved for young people with ED. Participant 1 responded with reference to TikTok. Extract 1 ( P 1) TikTok, you seem to, you know, you watch one video that might come up because, you know, you just watch it. You know you shouldn’t, but you do. And then you just get more and more and more. And it just sort of feeds itself and, you know, you can try and say not interested, but it- it’s- just sort of seems to be working against you sometimes. (P1) Here the participant emphasises a passive consumption of ED content – she ‘just watches’ one video that ‘come[s] up’ and then ‘gets more and more and more’. In contrast, the TikTok algorithm is depicted as highly agentive, consumptive (‘it just sort of feeds itself’) and hostile. The participant’s lack of agency is highlighted in the verb ‘try’ (‘you can try and say not interested’) which suggests there are limited options for curating the content the user is exposed to; this lack of agency juxtaposes with the more dynamic, personifying action of the algorithm as ‘working against you’. Throughout the extract, the participant uses the generic pronoun ‘you’ to express the experiences she describes, presenting this as a general experience that recurs for multiple people rather than an isolated incident. Overall, there is a distinct sense of lack of user control over the algorithm, with the algorithm itself personified as an entity that ‘feeds itself’. (Lack of) control is also a central topic in Extract 2, spoken by Participant 3. Extract 2 (P 3) Oh yeah, like, TikTok. Like, I scroll on there, but I don't post. But you never, you don't really have much control over what you see on TikTok, which is difficult. That is, I do think that is difficult. And I think there's a lot, like, because you never really know, like, if you interact with one post doing something, it might send more than [that]. Yeah, that's definitely, like, it's a social media that I do try and not go on as much because I can't control it as much. Like Instagram, you know, you can control who you follow. (P3) In this second extract, the algorithm is depicted as unknowable or unclear – ‘you never really know...it might send more’ – which suggests that attempts to push back against or “game” the algorithm (that is, deliberately alter the content that the algorithm shows) could be ineffective because users are not fully aware of how the algorithm might respond. There is a passivity to the user’s consumption of ED content – ‘I scroll on there’ – implying that users do not necessarily have to be active engagers with ED content to see this on their FYP. Equally, the personifying verb ‘send more’ suggests a very deliberate or conscious act on behalf of the algorithm, again highlighting technological agency in contrast to the user’s expression of disempowerment. Participant 3 also emphasises that they ‘try not to go on as much’ – ‘try’ suggests that the participant, despite her best efforts, does not or cannot avoid the platform altogether. Extract 3 from Participant 9 highlights ‘easy access’ to ED content on TikTok and recognises a tension between wanting to recover and wanting to stay with the ED: Extract 3 (P 9) Yeah. It's so hard because I think a lot depends on the mental space that you're in as well, because for me sometimes, like, I'll be scrolling through and I'll be like, oh my goodness, I'm just not- I'm not working hard enough for my recovery, like from a disordered eating, like, perspective. I’m just not working hard enough. My recovery…like they're doing so much better than me. Then the other part of me is like, oh, God, they're doing, they're doing so well. Like, I don't want to be like that. I want to just stay in my old unhealthy ways. And then I end up falling down this rabbit hole of looking at these awful, like accounts on TikTok. And it's just such easy access. That's the real issue for me… is like such easy access to it. You can just see all these people's, like, What I Eat In A Days and it's all just like a banana for breakfast. (P9) The user engages in social comparison even for positive recovery behaviours. The metaphor of involuntarily ‘falling down this rabbit hole’ elucidates a lack of agency in the process of going from viewing one or two videos to looking at the accounts behind the videos and presumably watching their other content. This process is linked to ‘easy access’, which places some responsibility on the TikTok platform for making it easy to find and become further exposed to more ED content on the FYP. Meanwhile, TikTok as a platform is implicitly given an agentive role in providing ‘easy access’ to the ED content. Overall, theme 1 highlights easy-to-access ED content on TikTok. Participants suggest watching one distressing video can lead to ‘falling down [a] rabbit hole’ of viewing more and feeling like the algorithm is ‘feeding itself’ on their insecurities. Interviewees express lack of agency and do not suggest that they are responsible for ending up in spirals of ED content, using metaphors of involuntarily ‘falling’ that contrast against personifying the algorithm as actively working against them; while the user’s agency is backgrounded, the algorithm is depicted as powerful and uncontrollable. Theme 2: ‘Morbid curiosity’ Theme 2, ‘Morbid Curiosity’ (termed by one participant), refers to a scenario in which young people describe knowing how the TikTok algorithm works but having a “morbid curiosity” to view (potentially unhelpful) ED content because of their ED. When they do watch this content, more of it comes up on their FYP, causing a negative effect. There is also one situation in which the participant deliberately seeks out ED content they find distressing to maintain ED thoughts and behaviours. In this theme, the emphasis is on the tension between wanting and not wanting to view the pro-ED content that the algorithm generates. Theme 2 highlights how the ‘easy access’ to ED content on TikTok (extract 3) interacts with a temptation or compulsion to view. Participant 16 describes a tension between a ‘tempt[ation]’ to click on the account that posted ED content that ‘came up on [her] for you page’ and an internal ‘disappoint[ment]’ in herself for viewing it: Extract 4 (P16) And like I don't know, it's a very strange one because like I… there is a feature. There's a tool on TikTok which is like you can hold down and say not interested. And I have done that. I don't, but like I can't lie and say that there wasn't part of me that went, what the hell? And I clicked on the account and as much as it, like, disappoints me like I…I was always tempted, whenever it came up on my For You Page, I always wanted to look at the account, like, as much, and like, I hated myself for it. But I would. And then I would maybe [click] not interested. But I never sought it out. That's the thing that really like, yeah, was strange for me. (P16). In this extract, the participant repeatedly describes the experience of a compulsion to consume ED content by clicking on the account behind the video as ‘strange’, suggesting a feeling of disorientation at the tension between not wanting to view the content and the feeling of temptation to look further into it. The words ‘disappoints’ and ‘hated’ point to a strong emotional reaction to the temptation to view, suggesting a degree of self-blame for following through on the compulsion, even though the participant clearly says that she has tried to avoid the videos by ‘hold[ing] down and say[ing] not interested’. That the participant references saying ‘not interested’ echoes Participant 1 in suggesting that some young people do try to implement strategies to avoid “unhelpful” content. However, here, because the user views the accounts behind the posts (thereby signalling a degree of interest in the content), attempts at recovery by clicking ‘not interested’ are thwarted. In other words, clicking ‘not interested’ might not have been effective this time because it was combined with an indicator of interest in these types of posts (the viewing of the accounts behind the posts). Overall, the extract suggests that although users are often advised societally that they should curate feeds or use buttons like ‘not interested, it can be challenging even to be presented with this choice in the first place. In Extract 5, Participant 8 describes a process of ’giving in’ to a compulsion to view ED content: Extract 5 (P 8) I know how the algorithm works and I still get sucked into their like sick pics and all that kind of thing. And I know that the more I engage with them, the more it's going to show me. But it's just so hard to scroll past all the like, What I Eat In A Day and like all that kind of thing. It started showing me weight loss ones recently, which is like so opposite of… it's either recovery or weight loss now and it's ridiculous. And I know that it's ridiculous, but it's still so kind of compelling that I can't help myself. (P8) This extract expresses explicit knowledge of how the TikTok algorithm works through the repetition of ‘I know’ and the understanding that ‘the more I engage with them, the more it’s going to show me’. This foregrounding of knowledge strikingly juxtaposes with the sentiments of ‘I can’t help myself’, and being ‘sucked in’ by ‘compelling’ content provision, all of which highlight disempowerment in the face of the potent combination of technology and disorder. Participant 8 suggests that the algorithm does not distinguish between ‘recovery’ and ‘weight loss’ content (‘it’s either recovery or weight loss now’), indicating that there is scope for the algorithm to “get it wrong” and show exactly the opposite of what the user is looking for. More explicitly, though, this extract suggests that even knowing how the algorithm works still does not result in agency for the user(s), as they may be unable to help themselves in the face of content they find compelling. Participant 15 explicitly uses the term ‘morbid curiosity’ to describe a process in which ‘your head will just make you keep seeking out that content even though you know it’s going to be tougher’: Extract 6 (P 15) And on TikTok, I know you can’t mute, but you can, like, suggest it show posts like this less or something. But, like, I think like I said, because of the algorithms, it is really hard to kind of avoid that. Because I think as well there's also this morbid curiosity, it's like sometimes your head will just make you keep seeking out that content even though you know it's going to be tougher. I think that that's where that sort of curiosity comes into it, where you like, you almost want to seek it out so that you end up feeling worse, which makes no sense. What we're doing just sort of doesn't make sense, I think. Yeah. I definitely need to try to, like, mute and block things that I don't want to see. Like when I'm in a healthy sort of state of mind. (P15) This extract exudes a sense of self-awareness of the paradox of knowingly consuming harmful content. It is underpinned by a duality in which the participant’s ‘head’ autonomously seeks out the content whereas the ‘healthy state of mind’ desires not to see the content. Like in Extract 5, the participant highlights a range of strategies they could use to ‘avoid’ ED content – ‘muting’,‘blocking’ and expressing that they would like to ‘see posts like this less’ (the button others call ‘not interested’). However, she suggests these might be ineffective in the face of an eating disorder or mental ill-health generally – she says that she ‘definitely need[s] to try to’ implement these strategies but implies that this is only possible ‘when [she’s] in a healthy sort of state of mind’. Again, then, the question of whether a young person must be in a particular mindset at any given point to be able to push back against the ’morbid curiosity’ to view is raised. If this is the case, the strategies available to young people on TikTok (blocking, muting, expressing their lack of interest in a post) may be less effective for those who are most vulnerable, or at the peak of their ED. Extract 6 also introduces the concept of deliberately seeking out disordered eating content in order to maintain an ED. Similarly, in Extract 7 Participant 7 describes being compelled by ‘the toxic part’ of her brain to go ‘searching’ and ‘look for photos’ where other people are ‘underweight’: Extract 7 (P7) Then the toxic part of my brain then goes, like, searching, because then I'll click on their profile and, like, look for photos when they're underweight because I'm like… which obviously I don't want to do, but you just… You just can't help yourself sometimes. (P7). Extract 7 displays a similar duality, causing a confrontation between the part of the brain viewed as ‘toxic’ and the part of the brain that wants to be healthy. The underlying suggestion is that TikTok exaggerates the rift between the self that wants to get better and the ‘toxic’ side of the self that wants to continue looking for photos of underweight bodies, with the latter often gaining the upper hand. In this way, the extract implies that there is a particular and potentially harmful interdependence between what the user brings and what the algorithm offers, and the extract helps to explain users’ continued participation on a platform that, at least in part, they identify as harmful. Overall, Themes 1 and 2 present users as fighting against both the algorithm and the existing compulsion to engage with content that they know will be deleterious. In other words, the algorithm selects harmful content that the young people know they will be ‘tempted’, ‘curious’ or ‘compelled’ to engage with. Here, the algorithm is again imbued with agency and power while the user lacks the agency to control the content they view, either due to the algorithm itself or a compulsion to view more content once it is initially displayed. Theme 3: From Helpful to Unhelpful The final theme, From Helpful to Unhelpful, encapsulates scenarios in which there is a trajectory from more positively-oriented or neutral content towards explicitly “unhelpful” content. It frames engagement with ED content as more dependent on TikTok algorithms than the individual viewing the content, either because the algorithm does not distinguish between what is pro-recovery content and what is not, or because it encourages viral challenges that young people explicitly evaluate as “unhelpful” for their recovery (e.g, What I Eat In A Day). This trajectory is illustrated in Extracts 8 and 9 below: Extract 8 (P 6) It’s the algorithm, so, like, once you like a video, you get more of them. So, I think I might have liked someone's eating disorder recovery video. And then now I get ones that are just related to disordered eating, and, like, I just can't stop them from, like, coming up on my page. (P6) Extract 9 (P 21) And even if it's, you know, it's harmful and you know you don't want to look at it, sometimes it gets accidentally put up for you, or sometimes it's something that they want to look at it, and it's knowing it's out there. (P21) Extract 8 exudes some similarity to the View One, See More theme in that it suggests that once you engage with one piece of content, you will be exposed to more of it. However, it also indicates that the algorithm cannot distinguish between what is pro-recovery and what is pro-ED content; someone who wants to view positively oriented videos may well be exposed to more harmful content even if they have not searched for it. This suggests the TikTok algorithm would need to be fine-tuned to capture vital differences between pro- and anti-recovery content rather than assuming all ED-related content is the same. Notably, Extract 8 also expresses a sense of helplessness – ‘I just can’t stop them’ which indicates a need for improved efficacy of embedded functions that allow users to curate their feed (e.g., the ‘not interested’ button). In Extract 9, the participant presents a variety of options for how YP might come across ED content on TikTok – it might get ‘accidentally put up for you’ (an expression which again suggests the indifference of the TikTok algorithm as an instrument for content curation) or a participant might go looking for it. Here, TikTok is the source of the easy access to the content that facilitates the compulsion to view – ‘it’s knowing it’s out there’. Overall, Theme 3 reinforces the lack of user agency on the TikTok platform but at the same time as highlighting the power of the algorithm, it also positions it as an indifferent instrument that is not always able to distinguish between pro-ED and pro-recovery content. Consequently, it raises questions about the need for a more nuanced algorithm that can recognise differences in content so that it does not group together all ED or weight-loss related videos and offer them to potentially vulnerable users. Discussion This interview study sought to illuminate how young people with experience of EDs perceive the viewing of ED content on TikTok. The interviewees express varying degrees of powerlessness with regards to ED content on TikTok and their vulnerability as a consequence of this. This is, in all extracts, related to the function of the platform’s algorithm. The participants’ feelings of powerless range from being exposed to harmful content without wanting to see it and without being able to control it (Theme 3, From Helpful to Unhelpful), to not being able to control the constant flow of content that is initiated even if they have only engaged with it once or twice (Theme 1, View One, See More). Even for participants who describe more deliberate engagement with pro-ED videos, they still present themselves as powerless to subsequently shift out of the echo chamber of ED content that the algorithm creates for them (Theme 2, Morbid Curiosity). Overall, participants describe engaging with a platform that they perceive to be harmful and largely beyond their control, but which they may nevertheless feel compelled to participate in whether out of ‘morbid curiosity’ towards the content it provides, or more conventional peer pressure to participate in a media environment that is highly popular among their demographic. The way in which users articulate their relationship to TikTok’s algorithm reveals its particular potency and potential for harm; the participants express that they engage with TikTok in full knowledge that the algorithm will use even a one-time interest in ED-content and ‘feed off it’. This means that the control over content is often out of their hands and content-delivery has the potential to spiral out of control. We have seen that this can be regarding the quantity of content, i.e. the algorithm provides much more of the same content than initially asked for, or regarding the quality of the content, i.e. the algorithm moves from presenting ED-related content that is initially helpful to that which is unhelpful or even harmful. A combination of both is also possible. The different forms of personification attributed to the algorithm are striking in the extracts. They highlight the agency that users attribute to it as an entity that takes over and gains more and more control while the user becomes increasingly powerless, trapped and vulnerable – they have ‘fallen down the rabbit hole’, as one participant puts it. In addition, the metaphor of ‘feeding off’ something or someone, like a leech, highlights both the difficulty of shaking off this entity, and the notion of becoming weaker while it grows stronger. Finally, the expression ‘you can try and say not interested, but it – it’s [...] working against you’ resonates uncomfortably with notions of physical and emotional violation – the user’s ‘not interested’, requesting a stop of activities, is neither registered nor respected. It is the complexity of this ‘relationship’ with the algorithm that needs to be considered when evaluating the feelings expressed by young people with EDs around their engagement with this highly popular platform that plays such an important part in the lives of their peers. Participants express their engagement with ED-content on TikTok as something ‘they shouldn’t do’, something they recognise as not good for them and potentially harmful, yet also as something they feel strongly attracted to. They direct resulting feelings of guilt or blame about this engagement at themselves, and not directly at the platform. In addition, close analysis shows that users express the dynamic of these feelings not as predominantly caused by their interest in online ED-content per se but regarding their engagement with the algorithm – in full knowledge of its workings. This knowledge does not make them less vulnerable to its unhelpful mechanisms, though, especially when the socio-cultural role as well as information and entertainment value of this platform is so high among young people (McCashin and Murphy, 2023). Our research also suggests that some of the limited strategies young people have available to them to avoid unhelpful content on TikTok, such as the “not interested” button, may be less effective for those who are in the most vulnerable state of their ED, because ‘morbid curiosity’ leads them to watch the videos that appear on their FYP, click through to the accounts posting this content, or go actively searching for photos that they find disturbing. The YP interviewed for this study suggested they had to be in a particular mindset to be able to use some of the functions of the app available to them (e.g. muting, clicking “not interested”) – a mindset that enables them to overcome the temptation to view content they find unhelpful or harmful. Similarly, other YP indicated that the TikTok algorithm was in some ways a blunt instrument that could not distinguish between pro-recovery and pro-ED content, and therefore showed potentially unhelpful content to those who did not search for it. Together, these findings highlight both the necessity of adding nuances to the TikTok algorithm so that it can distinguish between helpful and potentially harmful content and improving the functionality of existing measures so that it can support vulnerable users. This study has some limitations that are important to consider: namely, that all the participants whose extracts are analysed identified as female and typically had experience of AN rather than a range of diagnoses. Future qualitative research on the effect of TikTok algorithms and pro-ED content on those with lived experience must consider how different diagnoses might interact with the algorithm and pro-ED content in different ways, to produce different types of lived experience. It is critically important to also engage boys and young men in this research; while we did interview young men, none of the men spoke about TikTok. In retrospect, asking specifically about image-based platforms like TikTok (which appear to be more harmful to body image than text-based platforms (Mazzeo et al., 2024) would have provided greater insight from a more balanced gender perspective. That this study is the first to qualitatively consider the effect of ED content on TikTok among young people in the UK is an obvious strength. It supports existing quantitative research on TikTok algorithms and ED content (Griffith et al., 2024) while at the same time privileging the voices and experiences of those who navigate pro-ED content, TikTok algorithms, and their ED every day. The research also has the potential to enrich clinical understanding of the effects of TikTok on YP with EDs. McCashin and Murphy (2023) argue that there is limited understanding of the functionality of TikTok among mental health professionals; by providing an insight into the lived experience of TikTok algorithms for those with EDs, we hope to encourage clinicians to further consider the role of image-based platforms in ED prevention, treatment and care, particularly given the global reach and widespread youth use of these social media platforms. Conclusions This paper provides a lived experience perspective on what echo-chambers of ED content on TikTok can be like for YP. Our findings have a number of important implications for policy, research, and practice. A key recommendation to regulatory bodies (e.g., OFCOM in the UK), and TikTok itself is to improve functions of the platform that make it safer for those who choose to engage with it – in other words, implement a harm-reduction policy (see Mazzeo et al., 2024). This includes implementing effective functionality: 1) effective ‘not interested’ buttons, 2) preventing unhelpful content being displayed on the back of consuming ‘helpful’ content. Greater transparency on how the algorithm determines what content to show to users is also required. Additionally, there should be consideration generally about approaches to ED-related content and how to manage/mitigate this. Improving understanding of the effects of image-based platforms like TikTok on YP with MH issues should include involvement with researchers, clinicians, patient-carer organisations (e.g. Beat in the UK) and YP themselves in changing policies. In terms of research implications, this paper has laid the groundwork for investigations into lived experiences of the TikTok algorithm, pro-ED content, and eating disorders. Future studies should take forward these findings by examining different populations, including boys and young men, people of colour, and people with ED diagnoses other than AN. In terms of practice, raising awareness of the potentially detrimental effect of TikTok among young people themselves and among healthcare professionals and others working with young people will be a critical starting point. Such awareness can support the development of informed, collaborative and supportive dialogue around social media use and its effects. For example, two of the authors of the present paper collaborated with the UK national eating disorder charity Beat to facilitate the co-production of digital resources to support YP who post or engage with ED recovery-based social media in (a) posting sensitively and (b) viewing content mindfully (see EDIFY, n.d.). Targeted school-based interventions on increasing social media literacy have been demonstrated to be effective in the prevention and treatment of EDs (Fitzsimmons-Craft et al., 2020; Faccio et al., 2024; Schmidt et al., 2016) via facilitating discussions intended to help young people to critically evaluate the advantages and disadvantages of TikTok, and to navigate the site with awareness and intention. Such programmes might also be delivered via digital interventions. As Mazzeo et al., (2024) recognise, it is crucial for such interventions to be culturally sensitive and include girls and boys. This paper presents novel research exploring the experiences of participants with lived experience of ED and their engagement with ED content on TikTok. Using linguistic analysis of narrative extracts from YP in the U.K., we found that participants’ descriptions of TikTok’s personalised algorithm suggest it may interact with, and in some cases exacerbate, ED-related behaviours and cognitions, leading users into harmful echo-chambers of ED content. These findings support the argument that image-based platforms such as TikTok should take greater responsibility for the role of algorithmic curation in the intensification of ED symptoms and enhance mechanisms that allow users to manage the content they encounter online. Declarations Ethics approval and consent to participate Ethics approval for this study was awarded by the University of Nottingham. All participants signed informed consent forms and were given the opportunity to pause or leave the study at any time, including after the interview. Consent for publication Informed consent forms included consent for publication in academic and non-academic outputs, including written academic papers and oral presentations. Competing interests The authors have no competing interests to declare. Funding This work is supported by the Medical Research Council/Arts and Humanities Research Council/Economic and Social Research Council Adolescence, Mental Health and the Developing Mind initiative as part of the EDIFY programme (grant number MR/W002418/1) Authors’ contributions T.P.: concept of study, transcription of interviews, conducting interviews, analysis and interpretation of data, writing of main manuscript, contextualisation of findings, review of manuscript H.B.: concept of study, analysis and interpretation of data, writing of main manuscript, contextualisation of findings, review of manuscript D.H.: analysis and interpretation of data, writing of manuscript, contextualisation of findings, review of manuscript J.W: interpretation of data, contextualisation of findings, review of manuscript B.İ.: contextualisation of findings, review of manuscript U.S.: contextualisation of findings, review of manuscript H.S.: contextualisation of findings, review of manuscript Acknowledgments We would like to thank all participants of the study for being open and sharing their stories with us. 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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-7283049","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":503034015,"identity":"99111b6f-f604-41c1-8c70-fae9a8f594bc","order_by":0,"name":"Tamsin Parnell","email":"","orcid":"","institution":"The University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Tamsin","middleName":"","lastName":"Parnell","suffix":""},{"id":503034016,"identity":"75362b93-9275-42f7-bbad-8cf61ec11cad","order_by":1,"name":"Daniel Hunt","email":"","orcid":"","institution":"The University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Hunt","suffix":""},{"id":503034017,"identity":"afa18329-b5b9-4892-acc9-47229c9f0357","order_by":2,"name":"Jessica Wilkins","email":"","orcid":"","institution":"King's College London","correspondingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"","lastName":"Wilkins","suffix":""},{"id":503034018,"identity":"bb8aa058-7e67-4d19-8392-b6145bce41d7","order_by":3,"name":"Başak İnce","email":"","orcid":"","institution":"The University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Başak","middleName":"","lastName":"İnce","suffix":""},{"id":503034020,"identity":"32f624aa-17e2-4b53-a522-57b2984c7f1b","order_by":4,"name":"Schmidt Ulrike","email":"","orcid":"","institution":"King's College London","correspondingAuthor":false,"prefix":"","firstName":"Schmidt","middleName":"","lastName":"Ulrike","suffix":""},{"id":503034021,"identity":"331c0890-4c39-481e-90ab-eb0f575c18a1","order_by":5,"name":"Helen Sharpe","email":"","orcid":"","institution":"University of Edinburgh","correspondingAuthor":false,"prefix":"","firstName":"Helen","middleName":"","lastName":"Sharpe","suffix":""},{"id":503034023,"identity":"039fc35f-225c-41dc-89b2-383bb25abd61","order_by":6,"name":"Heike Bartel","email":"data:image/png;base64,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","orcid":"","institution":"King's College London","correspondingAuthor":true,"prefix":"","firstName":"Heike","middleName":"","lastName":"Bartel","suffix":""}],"badges":[],"createdAt":"2025-08-03 11:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7283049/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7283049/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40337-025-01505-6","type":"published","date":"2025-12-20T15:57:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":98814079,"identity":"0b48a0d6-1c7e-462d-9b5b-88d8a3a8873f","added_by":"auto","created_at":"2025-12-22 16:10:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":575689,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7283049/v1/f7102367-dbbd-4b7d-ae9f-cdeeaa3c60f3.pdf"},{"id":89822877,"identity":"526fda37-7354-4632-9f40-6bbc4149868c","added_by":"auto","created_at":"2025-08-25 11:58:03","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16195,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7283049/v1/85a1bec4bdc8d0e7fc0ec396.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"‘Falling down the rabbit hole’: a thematic analysis of young people’s views on TikTok algorithms and eating disorder content","fulltext":[{"header":"Plain English summary","content":"\u003cp\u003eThis study explored how young people with a current or past eating disorder (EDs) describe their experience of viewing ED content on the social media platform TikTok and how this affects their ED and recovery. We interviewed 17 UK-based young people (aged 16-25) with lived experience of an ED. Data showed that the personal experience with the TikTok algorithm – which shows curated content to each user through its ‘For You Page’ – can lead users into ‘negative spirals’ of ED content, increasingly flooding them with ED materials. This can affect, interact with and, in some cases, worsen ED-related thoughts and behaviours of the young people.\u0026nbsp;\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eYoung people\u0026rsquo;s use of SM is \u0026lsquo;almost ubiquitous\u0026rsquo; (Yang, Holden and Ariati, 2021: 631). SM allows young people to develop social connections (Radovic et al., 2017) and engage in civic and political life (Boulianne and Theocharis, 2018). It enables them to practise identity and relationship management strategies (Wang and Edwards, 2016) and can support elements of educational and cognitive development (Gray, 2018). However, Valkenburg, Meier and Beyens (2022) warn that SM also offers young people opportunities to engage in risky behaviours outside of parental oversight. As adolescence is a time when well-being shows the most fluctuations (Maciejewski et al., 2019) and risk-taking is at a peak (Steinberg, 2007), parents, policymakers and scholars seek to understand the effects of social media use (SMU) on youth mental health (Valkenburg, Meier and Beyens, 2022). This also includes more research into the addictive potential and psychological and behavioural impacts of the platform as highlighted by Caponnetto et al. (2025).\u003c/p\u003e\u003cp\u003eThe porous borders between helpful and unhelpful SM content are particularly salient for young people with EDs and their online engagement with ED-related content. Research into the role of the internet for those affected by EDs has established a positive impact with regards to community building (Greene et al., 2023, Greene and Norling, 2023, Lookingbill et al., 2023, Bartel and Downs, 2024), social support and validation (Au and Cosh, 2022) and reducing barriers to help-seeking (Kendal et al., 2015). However, studies have also identified harmful effects of online spaces for people with EDs. Numerous projects have analysed pro-ED websites (Rouleau and von Ranson, 2011; Peebles et al., 2012; Steakley-Freeman et al., 2015) and pro-ED accounts on SM sites such as Twitter/X (Arseniev-Koehler et al., 2016) and Instagram (Goh et al., 2022). These studies have recognised the fine line between helpful and unhelpful or even harmful content in which even spaces that are ostensibly pro-recovery can include unhelpful and potentially harmful content on diet culture, triggering imagery, and appearance.\u003c/p\u003e\u003cp\u003eWhile previous studies have addressed the role of health forums or SM applications like Instagram in exacerbating ED symptoms, recent research has begun to consider ED and ED recovery content on TikTok (see, for example, Herrick et al., 2021; Griffiths et al., 2024). TikTok is an algorithm-driven application that, among other things, allows users to consume and create short-form video content (Herrick et al., 2021; McCashin and Murphy, 2023). The application has extensive global reach, is popular with young people, and sees high levels of engagement with mental health content (Greene et al., 2023). TikTok is therefore \u0026lsquo;emerging as a pivotal tool\u0026rsquo; (Rejeb et al., 2024) for health information dissemination with attendant concerns about the quality of content and dis/misinformation (Eghtesadi \u0026amp; Florea, 2020; Zheng et al., 2021), as well as the potential to exacerbate ED symptoms (Griffiths et al., 2024; see below).\u003c/p\u003e\u003cp\u003eExisting studies on TikTok and EDs have typically categorised the type of content found under disorder-specific hashtags, such as #anarecovery and #arfidrecovery (Greene et al., 2023) and general recovery hashtags, such as #EDrecovery (Herrick et al., 2021). At the time of writing (April 2025), the #EDrecovery tag is used in over 323,000 TikTok videos. Previous studies (e.g., Davis et al., 2023; Herrick et al., 2021) have identified the prevalence of a TikTok challenge called What I Eat In A Day (WIEIAD), which sees content creators document what they have consumed throughout the day, often in an ED recovery context. The genre of WIEIAD videos reflects the public mundanity of much social media content (e.g., Get Ready with Me videos, or GRWM), which focuses on \u0026ldquo;everyday-ness\u0026rdquo;. However, WIEIAD videos are given particular significance in the context of ED recovery because they can encourage comparison or promote unhealthy behaviours including rigid monitoring of food and exercise. For example, Davis et al. (2023) thematically categorised 100 videos posted to the hashtag #WhatIEatInADay, finding 15 videos in which creators discussed engagement in disordered eating behaviours such as misusing laxatives and skipping meals (2023). In addition to the What I Eat In A Day trend, Herrick et al. (2021) also identified that some users post weight gain \u0026ldquo;glow ups\u0026rdquo; under the hashtag #EDrecovery; in these posts, two contrasting pictures show a body at a very low weight and the same weight-restored body.\u003c/p\u003e\u003cp\u003eWhat sets TikTok apart from other SM platforms is the centrality of its content selection algorithm, which determines what appears on each user\u0026rsquo;s For You Page (FYP, a page which shows personalised content to each user). In comparison to other SM platforms such as Instagram or X (formerly Twitter), TikTok places less emphasis on following and subscribing to accounts, leading to a much less explicit representation of the user\u0026rsquo;s network from which the content they see is drawn; instead, the algorithm directs the flow of content. In other words, although algorithms are used across a wide range of SM, TikTok is the only platform that puts the algorithm at the core of the social experience it offers its users (Bhandari et al., 2022).\u003c/p\u003e\u003cp\u003eA recent study by Griffiths et al. (2024) indicates that TikTok\u0026rsquo;s algorithm may exacerbate eating disorder symptoms. Building on the work of a \u003cem\u003eWall Street Journal\u003c/em\u003e (2021) investigation into how TikTok\u0026rsquo;s algorithm works, the study suggests the algorithm is sensitised to how long a user watches a video for. This means that the longer someone watches a video, the more likely they are to see similar content on their FYP. In the context of EDs, Griffiths et al. imagine a scenario in which a young person engages with, instead of scrolling past, a video that they might find less helpful for their ED because it, among other things, intensifies anxiety or encourages them to compare their appearance unfavourably to another person. This longer view-time increases the likelihood that the user will be exposed by the algorithm to \u003cem\u003emore\u003c/em\u003e of this unhelpful content on their FYP. In short, a vulnerable user could find themselves in a situation whereby they are repeatedly exposed to ED-related videos because the algorithm has identified this type of content as something with which the user engages, either actively or passively.\u003c/p\u003e\u003cp\u003eAs mental health professionals may have a limited understanding of the functionality of the TikTok algorithm and how it might exacerbate symptoms of mental illness (McCashin and Murphy 2023), it is necessary to develop research in this area that can enrich clinical understandings of how exposure to the TikTok algorithm can affect YP with EDs. Here, we offer lived experience findings that can illustrate how TikTok\u0026rsquo;s algorithm interacts with ED content to affect YP with EDs. In so doing, we respond to longstanding calls to understand the complexities of online health information beyond reductive concerns with information accuracy and to consider users\u0026rsquo; consumptive practices and their nuanced effects (Nettleton, Burrows and O\u0026rsquo;Malley, 2005).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eRecruitment and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was granted by the University of Nottingham (approval reference code: R2324/022). Two UK ED charities, Beat and First Steps, helped with recruitment via social media (X, Instagram, TikTok), on websites and in newsletters.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants had to be aged between 16 and 25, live in the UK, have experienced an ED or disordered eating (with or without formal diagnosis), and have posted or viewed ED content on social media. In our recruitment material we highlighted that we would particularly like to hear from people currently underrepresented in ED narratives, including those who live rurally, identify as LGBTQ+, identify as ethnically or culturally diverse, and/or as experiencing resource insecurity. These lenses were chosen by young people as priorities as part of the EDIFY research project (LENS, n.d.; EDIFY, n.d.).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePotential participants completed an expression of interest (EOI) form and in response were sent study information and consent forms. Once they had given their written informed consent, an online interview was organised, and the research questions were shared (see Appendix 1 for interview questions).\u003c/p\u003e\n\u003cp\u003eIn total, there were 67 responses to the EOI form with 30 participants responding to a follow-up email and consenting to an online interview, which was held via Microsoft Teams. After the interview, each participant received a \u0026pound;15 voucher. While the interviews focused on participants\u0026rsquo; experiences of engaging with ED content on social media broadly, here we present data from 17 of these interviews in which participants spoke specifically about their TikTok use and its effects on them. Participants were not asked to disclose their specific type of disordered eating or ED, but as open questions encouraged them to share as much or as little as they felt comfortable sharing, many did disclose an ED diagnosis. All participants said that they used apps such as TikTok daily, although we did not ask about the time spent on social media. Table 1 presents the characteristics of the participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1: Participant characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant ID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLens(es)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis disclosed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLiving rurally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAnorexia nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLGBTQ+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAnorexia nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eResource insecurity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDisordered eating (self-diagnosis of orthorexia)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLiving rurally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAnorexia nervosa and bulimia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCultural diversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAtypical anorexia and then anorexia nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eResource insecurity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAnorexia nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eEthnic diversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDisordered eating\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLiving rurally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDisordered eating\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLGBTQ+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDisordered eating (self-diagnosis of bulimia)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLGBTQ+, resource insecurity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAnorexia nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLGBTQ+\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDisordered eating\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDoes not identify with our lenses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAnorexia (with bulimia)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eEthnic diversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAnorexia nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLGBTQ+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAnorexia nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e22\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLGBTQ+.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eBulimia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDoes not identify with our lenses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDisordered eating\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDoes not identify with our lenses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAnorexia nervosa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAnalytical process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analytical process we adopt in this project is thematic analysis (Braun and Clarke, 2006; Clarke and Braun, 2017). In line with Braun and Clarke (2006), we understand a theme to be a patterned response in our dataset that does not have to be the most quantitatively important pattern, but which contributes to an important aspect of meaning-making in the data. The data analysis process was inductive; we did not ask specific questions about TikTok algorithms and ED-related content during the interviews but rather found this was a prevalent topic across many of the interview responses and was therefore worthy of greater attention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTP transcribed the interviews from recordings. Three authors (TP, DH, HB) read the interview transcripts independently several times and identified codes and came together to discuss their findings and discovered overlaps, especially across the following codes: representations of agency, depictions of the algorithm as sentient or powerful, and consumption of ED content as compulsive. During these meetings these authors also reflected on their own experiences as social media users as well as our previous research with individuals with EDs and on online contexts and how these may have shaped their responses to the participants\u0026rsquo; data. Together, through extensive discussion, the authors generated the three \u0026ldquo;key\u0026rdquo; higher-level themes that brought together these codes by reflecting \u003cem\u003ehow\u0026nbsp;\u003c/em\u003ethe participants described their interaction with a powerful algorithm and a compulsion to view ED content through the lens of (lack of) user agency. The authors then selected extracts that reflected each of the key themes most closely. All three authors analysed the extracts independently to identify key linguistic features of interest related to agency, disempowerment, and depictions of the algorithm. The authors then came together again to share their findings and agree on a mutual interpretation of each of the extracts that would lend itself to an overall argument.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThroughout the interviews, there was one type of content that YP positioned as helpful on TikTok: images or videos of people with EDs having full and rich lives outside of their ED. Three types of content on TikTok were positioned by young people as \u0026ldquo;unhelpful\u0026rdquo; with regards to their disordered eating and ED. The \u0026ldquo;unhelpful\u0026rdquo; content was: (1) What I Eat In A Day challenges, (2) before and after pictures that visualised weight gain, and (3) gym and fitness content posted by ostensibly recovery-oriented accounts. Our thematic analysis delineated three dominant themes that account for participants\u0026rsquo; encounters with this type of content, and which seek to capture both participants\u0026rsquo; immediate experiences and the longer-term effects of consuming this content: \u0026lsquo;View One, See More\u0026rsquo;, \u0026lsquo;Morbid Curiosity\u0026rsquo; and \u0026lsquo;From Helpful to Unhelpful\u0026rsquo;\u003c/p\u003e\n\u003ch3\u003eTheme 1: View One, See More\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eView One, See More, refers to a pattern in which participants describe watching a single video and then being consistently exposed to more of that content, making it hard to escape from. The emphasis in this theme is on users\u0026rsquo; lack of control to stop the activities of the algorithm.\u003c/p\u003e\u003cp\u003eDuring the interview, we asked participants how social media could be improved for young people with ED. Participant 1 responded with reference to TikTok.\u003c/p\u003e\u003cp\u003e\u003cb\u003eExtract 1 (\u003c/b\u003eP 1)\u003c/p\u003e\u003cp\u003e\u003cem\u003eTikTok, you seem to, you know, you watch one video that might come up because, you know, you just watch it. You know you shouldn\u0026rsquo;t, but you do. And then you just get more and more and more. And it just sort of feeds itself and, you know, you can try and say not interested, but it- it\u0026rsquo;s- just sort of seems to be working against you sometimes.\u003c/em\u003e (P1)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHere the participant emphasises a passive consumption of ED content \u0026ndash; she \u0026lsquo;just watches\u0026rsquo; one video that \u0026lsquo;come[s] up\u0026rsquo; and then \u0026lsquo;gets more and more and more\u0026rsquo;. In contrast, the TikTok algorithm is depicted as highly agentive, consumptive (\u0026lsquo;it just sort of feeds itself\u0026rsquo;) and hostile. The participant\u0026rsquo;s lack of agency is highlighted in the verb \u0026lsquo;try\u0026rsquo; (\u0026lsquo;you can try and say not interested\u0026rsquo;) which suggests there are limited options for curating the content the user is exposed to; this lack of agency juxtaposes with the more dynamic, personifying action of the algorithm as \u0026lsquo;working against you\u0026rsquo;. Throughout the extract, the participant uses the generic pronoun \u0026lsquo;you\u0026rsquo; to express the experiences she describes, presenting this as a general experience that recurs for multiple people rather than an isolated incident. Overall, there is a distinct sense of lack of user control over the algorithm, with the algorithm itself personified as an entity that \u0026lsquo;feeds itself\u0026rsquo;.\u003c/p\u003e\u003cp\u003e(Lack of) control is also a central topic in Extract 2, spoken by Participant 3.\u003c/p\u003e\n\u003ch3\u003eExtract 2 (P 3)\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eOh yeah, like, TikTok. Like, I scroll on there, but I don't post. But you never, you don't really have much control over what you see on TikTok, which is difficult. That is, I do think that is difficult. And I think there's a lot, like, because you never really know, like, if you interact with one post doing something, it might send more than [that]. Yeah, that's definitely, like, it's a social media that I do try and not go on as much because I can't control it as much. Like Instagram, you know, you can control who you follow.\u003c/em\u003e (P3)\u003c/p\u003e\u003cp\u003eIn this second extract, the algorithm is depicted as unknowable or unclear \u0026ndash; \u0026lsquo;you never really know...it might send more\u0026rsquo; \u0026ndash; which suggests that attempts to push back against or \u0026ldquo;game\u0026rdquo; the algorithm (that is, deliberately alter the content that the algorithm shows) could be ineffective because users are not fully aware of how the algorithm might respond. There is a passivity to the user\u0026rsquo;s consumption of ED content \u0026ndash; \u0026lsquo;I scroll on there\u0026rsquo; \u0026ndash; implying that users do not necessarily have to be active engagers with ED content to see this on their FYP. Equally, the personifying verb \u0026lsquo;send more\u0026rsquo; suggests a very deliberate or conscious act on behalf of the algorithm, again highlighting technological agency in contrast to the user\u0026rsquo;s expression of disempowerment. Participant 3 also emphasises that they \u0026lsquo;try not to go on as much\u0026rsquo; \u0026ndash; \u0026lsquo;try\u0026rsquo; suggests that the participant, despite her best efforts, does not or cannot avoid the platform altogether.\u003c/p\u003e\u003cp\u003eExtract 3 from Participant 9 highlights \u0026lsquo;easy access\u0026rsquo; to ED content on TikTok and recognises a tension between wanting to recover and wanting to stay with the ED:\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eExtract 3 (P 9)\u003c/h2\u003e\u003cp\u003e\u003cem\u003eYeah. It's so hard because I think a lot depends on the mental space that you're in as well, because for me sometimes, like, I'll be scrolling through and I'll be like, oh my goodness, I'm just not- I'm not working hard enough for my recovery, like from a disordered eating, like, perspective. I\u0026rsquo;m just not working hard enough. My recovery\u0026hellip;like they're doing so much better than me. Then the other part of me is like, oh, God, they're doing, they're doing so well. Like, I don't want to be like that. I want to just stay in my old unhealthy ways. And then I end up falling down this rabbit hole of looking at these awful, like accounts on TikTok. And it's just such easy access. That's the real issue for me\u0026hellip; is like such easy access to it. You can just see all these people's, like, What I Eat In A Days and it's all just like a banana for breakfast.\u003c/em\u003e (P9)\u003c/p\u003e\u003cp\u003eThe user engages in social comparison even for positive recovery behaviours. The metaphor of involuntarily \u0026lsquo;falling down this rabbit hole\u0026rsquo; elucidates a lack of agency in the process of going from viewing one or two videos to looking at the accounts behind the videos and presumably watching their other content. This process is linked to \u0026lsquo;easy access\u0026rsquo;, which places some responsibility on the TikTok platform for making it easy to find and become further exposed to more ED content on the FYP. Meanwhile, TikTok as a platform is implicitly given an agentive role in providing \u0026lsquo;easy access\u0026rsquo; to the ED content.\u003c/p\u003e\u003cp\u003eOverall, theme 1 highlights easy-to-access ED content on TikTok. Participants suggest watching one distressing video can lead to \u0026lsquo;falling down [a] rabbit hole\u0026rsquo; of viewing more and feeling like the algorithm is \u0026lsquo;feeding itself\u0026rsquo; on their insecurities. Interviewees express lack of agency and do not suggest that they are responsible for ending up in spirals of ED content, using metaphors of involuntarily \u0026lsquo;falling\u0026rsquo; that contrast against personifying the algorithm as actively working against them; while the user\u0026rsquo;s agency is backgrounded, the algorithm is depicted as powerful and uncontrollable.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTheme 2: ‘Morbid curiosity’\u003c/h3\u003e\n\u003cp\u003eTheme 2, \u0026lsquo;Morbid Curiosity\u0026rsquo; (termed by one participant), refers to a scenario in which young people describe knowing how the TikTok algorithm works but having a \u0026ldquo;morbid curiosity\u0026rdquo; to view (potentially unhelpful) ED content because of their ED. When they \u003cem\u003edo\u003c/em\u003e watch this content, more of it comes up on their FYP, causing a negative effect. There is also one situation in which the participant deliberately seeks out ED content they find distressing to maintain ED thoughts and behaviours. In this theme, the emphasis is on the tension between wanting and not wanting to view the pro-ED content that the algorithm generates. Theme 2 highlights how the \u0026lsquo;easy access\u0026rsquo; to ED content on TikTok (extract 3) interacts with a temptation or compulsion to view.\u003c/p\u003e\u003cp\u003eParticipant 16 describes a tension between a \u0026lsquo;tempt[ation]\u0026rsquo; to click on the account that posted ED content that \u0026lsquo;came up on [her] for you page\u0026rsquo; and an internal \u0026lsquo;disappoint[ment]\u0026rsquo; in herself for viewing it:\u003c/p\u003e\n\u003ch3\u003eExtract 4 (P16)\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eAnd like I don't know, it's a very strange one because like I\u0026hellip; there is a feature. There's a tool on TikTok which is like you can hold down and say not interested. And I have done that. I don't, but like I can't lie and say that there wasn't part of me that went, what the hell? And I clicked on the account and as much as it, like, disappoints me like I\u0026hellip;I was always tempted, whenever it came up on my For You Page, I always wanted to look at the account, like, as much, and like, I hated myself for it. But I would. And then I would maybe [click] not interested. But I never sought it out. That's the thing that really like, yeah, was strange for me.\u003c/em\u003e (P16).\u003c/p\u003e\u003cp\u003eIn this extract, the participant repeatedly describes the experience of a compulsion to consume ED content by clicking on the account behind the video as \u0026lsquo;strange\u0026rsquo;, suggesting a feeling of disorientation at the tension between not wanting to view the content and the feeling of temptation to look further into it. The words \u0026lsquo;disappoints\u0026rsquo; and \u0026lsquo;hated\u0026rsquo; point to a strong emotional reaction to the temptation to view, suggesting a degree of self-blame for following through on the compulsion, even though the participant clearly says that she has tried to avoid the videos by \u0026lsquo;hold[ing] down and say[ing] not interested\u0026rsquo;. That the participant references saying \u0026lsquo;not interested\u0026rsquo; echoes Participant 1 in suggesting that some young people do try to implement strategies to avoid \u0026ldquo;unhelpful\u0026rdquo; content. However, here, because the user views the accounts behind the posts (thereby signalling a degree of interest in the content), attempts at recovery by clicking \u0026lsquo;not interested\u0026rsquo; are thwarted. In other words, clicking \u0026lsquo;not interested\u0026rsquo; might not have been effective this time because it was combined with an indicator of interest in these types of posts (the viewing of the accounts behind the posts). Overall, the extract suggests that although users are often advised societally that they should curate feeds or use buttons like \u0026lsquo;not interested, it can be challenging even to be presented with this choice in the first place.\u003c/p\u003e\u003cp\u003eIn Extract 5, Participant 8 describes a process of \u0026rsquo;giving in\u0026rsquo; to a compulsion to view ED content:\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eExtract 5 (P 8)\u003c/h2\u003e\u003cp\u003e\u003cem\u003eI know how the algorithm works and I still get sucked into their like sick pics and all that kind of thing. And I know that the more I engage with them, the more it's going to show me. But it's just so hard to scroll past all the like, What I Eat In A Day and like all that kind of thing. It started showing me weight loss ones recently, which is like so opposite of\u0026hellip; it's either recovery or weight loss now and it's ridiculous. And I know that it's ridiculous, but it's still so kind of compelling that I can't help myself.\u003c/em\u003e (P8)\u003c/p\u003e\u003cp\u003eThis extract expresses explicit knowledge of how the TikTok algorithm works through the repetition of \u0026lsquo;I know\u0026rsquo; and the understanding that \u0026lsquo;the more I engage with them, the more it\u0026rsquo;s going to show me\u0026rsquo;. This foregrounding of knowledge strikingly juxtaposes with the sentiments of \u0026lsquo;I can\u0026rsquo;t help myself\u0026rsquo;, and being \u0026lsquo;sucked in\u0026rsquo; by \u0026lsquo;compelling\u0026rsquo; content provision, all of which highlight disempowerment in the face of the potent combination of technology and disorder. Participant 8 suggests that the algorithm does not distinguish between \u0026lsquo;recovery\u0026rsquo; and \u0026lsquo;weight loss\u0026rsquo; content (\u0026lsquo;it\u0026rsquo;s either recovery or weight loss now\u0026rsquo;), indicating that there is scope for the algorithm to \u0026ldquo;get it wrong\u0026rdquo; and show exactly the opposite of what the user is looking for. More explicitly, though, this extract suggests that even knowing how the algorithm works still does not result in agency for the user(s), as they may be unable to help themselves in the face of content they find compelling.\u003c/p\u003e\u003cp\u003eParticipant 15 explicitly uses the term \u0026lsquo;morbid curiosity\u0026rsquo; to describe a process in which \u0026lsquo;your head will just make you keep seeking out that content even though you know it\u0026rsquo;s going to be tougher\u0026rsquo;:\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eExtract 6 (P 15)\u003c/h2\u003e\u003cp\u003e\u003cem\u003eAnd on TikTok, I know you can\u0026rsquo;t mute, but you can, like, suggest it show posts like this less or something. But, like, I think like I said, because of the algorithms, it is really hard to kind of avoid that. Because I think as well there's also this morbid curiosity, it's like sometimes your head will just make you keep seeking out that content even though you know it's going to be tougher. I think that that's where that sort of curiosity comes into it, where you like, you almost want to seek it out so that you end up feeling worse, which makes no sense. What we're doing just sort of doesn't make sense, I think. Yeah. I definitely need to try to, like, mute and block things that I don't want to see. Like when I'm in a healthy sort of state of mind.\u003c/em\u003e (P15)\u003c/p\u003e\u003cp\u003eThis extract exudes a sense of self-awareness of the paradox of knowingly consuming harmful content. It is underpinned by a duality in which the participant\u0026rsquo;s \u0026lsquo;head\u0026rsquo; autonomously seeks out the content whereas the \u0026lsquo;healthy state of mind\u0026rsquo; desires not to see the content. Like in Extract 5, the participant highlights a range of strategies they could use to \u0026lsquo;avoid\u0026rsquo; ED content \u0026ndash; \u0026lsquo;muting\u0026rsquo;,\u0026lsquo;blocking\u0026rsquo; and expressing that they would like to \u0026lsquo;see posts like this less\u0026rsquo; (the button others call \u0026lsquo;not interested\u0026rsquo;). However, she suggests these might be ineffective in the face of an eating disorder or mental ill-health generally \u0026ndash; she says that she \u0026lsquo;definitely need[s] to try to\u0026rsquo; implement these strategies but implies that this is only possible \u0026lsquo;when [she\u0026rsquo;s] in a healthy sort of state of mind\u0026rsquo;. Again, then, the question of whether a young person must be in a particular mindset at any given point to be able to push back against the \u0026rsquo;morbid curiosity\u0026rsquo; to view is raised. If this is the case, the strategies available to young people on TikTok (blocking, muting, expressing their lack of interest in a post) may be less effective for those who are most vulnerable, or at the peak of their ED.\u003c/p\u003e\u003cp\u003eExtract 6 also introduces the concept of deliberately seeking out disordered eating content in order to maintain an ED. Similarly, in Extract 7 Participant 7 describes being compelled by \u0026lsquo;the toxic part\u0026rsquo; of her brain to go \u0026lsquo;searching\u0026rsquo; and \u0026lsquo;look for photos\u0026rsquo; where other people are \u0026lsquo;underweight\u0026rsquo;:\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eExtract 7 (P7)\u003c/h2\u003e\u003cp\u003e\u003cem\u003eThen the toxic part of my brain then goes, like, searching, because then I'll click on their profile and, like, look for photos when they're underweight because I'm like\u0026hellip; which obviously I don't want to do, but you just\u0026hellip; You just can't help yourself sometimes. (P7).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eExtract 7 displays a similar duality, causing a confrontation between the part of the brain viewed as \u0026lsquo;toxic\u0026rsquo; and the part of the brain that wants to be healthy. The underlying suggestion is that TikTok exaggerates the rift between the self that wants to get better and the \u0026lsquo;toxic\u0026rsquo; side of the self that wants to continue looking for photos of underweight bodies, with the latter often gaining the upper hand. In this way, the extract implies that there is a particular and potentially harmful interdependence between what the user brings and what the algorithm offers, and the extract helps to explain users\u0026rsquo; continued participation on a platform that, at least in part, they identify as harmful.\u003c/p\u003e\u003cp\u003eOverall, Themes 1 and 2 present users as fighting against both the algorithm and the existing compulsion to engage with content that they know will be deleterious. In other words, the algorithm selects harmful content that the young people know they will be \u0026lsquo;tempted\u0026rsquo;, \u0026lsquo;curious\u0026rsquo; or \u0026lsquo;compelled\u0026rsquo; to engage with. Here, the algorithm is again imbued with agency and power while the user lacks the agency to control the content they view, either due to the algorithm itself or a compulsion to view \u003cem\u003emore\u003c/em\u003e content once it is initially displayed.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3: From Helpful to Unhelpful\u003c/h2\u003e\u003cp\u003eThe final theme, From Helpful to Unhelpful, encapsulates scenarios in which there is a trajectory from more positively-oriented or neutral content towards explicitly \u0026ldquo;unhelpful\u0026rdquo; content. It frames engagement with ED content as more dependent on TikTok algorithms than the individual viewing the content, either because the algorithm does not distinguish between what is pro-recovery content and what is not, or because it encourages viral challenges that young people explicitly evaluate as \u0026ldquo;unhelpful\u0026rdquo; for their recovery (e.g, What I Eat In A Day). This trajectory is illustrated in Extracts 8 and 9 below:\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eExtract 8 (P 6)\u003c/h2\u003e\u003cp\u003e\u003cem\u003eIt\u0026rsquo;s the algorithm, so, like, once you like a video, you get more of them. So, I think I might have liked someone's eating disorder recovery video. And then now I get ones that are just related to disordered eating, and, like, I just can't stop them from, like, coming up on my page.\u003c/em\u003e (P6)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eExtract 9 (P 21)\u003c/h2\u003e\u003cp\u003e\u003cem\u003eAnd even if it's, you know, it's harmful and you know you don't want to look at it, sometimes it gets accidentally put up for you, or sometimes it's something that they want to look at it, and it's knowing it's out there.\u003c/em\u003e (P21)\u003c/p\u003e\u003cp\u003eExtract 8 exudes some similarity to the View One, See More theme in that it suggests that once you engage with one piece of content, you will be exposed to more of it. However, it also indicates that the algorithm cannot distinguish between what is pro-recovery and what is pro-ED content; someone who wants to view positively oriented videos may well be exposed to more harmful content even if they have not searched for it. This suggests the TikTok algorithm would need to be fine-tuned to capture vital differences between pro- and anti-recovery content rather than assuming all ED-related content is the same. Notably, Extract 8 also expresses a sense of helplessness \u0026ndash; \u0026lsquo;I just can\u0026rsquo;t stop them\u0026rsquo; which indicates a need for improved efficacy of embedded functions that allow users to curate their feed (e.g., the \u0026lsquo;not interested\u0026rsquo; button).\u003c/p\u003e\u003cp\u003eIn Extract 9, the participant presents a variety of options for how YP might come across ED content on TikTok \u0026ndash; it might get \u0026lsquo;accidentally put up for you\u0026rsquo; (an expression which again suggests the indifference of the TikTok algorithm as an instrument for content curation) or a participant might go looking for it. Here, TikTok is the source of the easy access to the content that facilitates the compulsion to view \u0026ndash; \u0026lsquo;it\u0026rsquo;s knowing it\u0026rsquo;s out there\u0026rsquo;.\u003c/p\u003e\u003cp\u003eOverall, Theme 3 reinforces the lack of user agency on the TikTok platform but at the same time as highlighting the power of the algorithm, it also positions it as an indifferent instrument that is not always able to distinguish between pro-ED and pro-recovery content. Consequently, it raises questions about the need for a more nuanced algorithm that can recognise differences in content so that it does not group together all ED or weight-loss related videos and offer them to potentially vulnerable users.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis interview study sought to illuminate how young people with experience of EDs perceive the viewing of ED content on TikTok. The interviewees express varying degrees of powerlessness with regards to ED content on TikTok and their vulnerability as a consequence of this. This is, in all extracts, related to the function of the platform\u0026rsquo;s algorithm. The participants\u0026rsquo; feelings of powerless range from being exposed to harmful content without wanting to see it and without being able to control it (Theme 3, From Helpful to Unhelpful), to not being able to control the constant flow of content that is initiated even if they have only engaged with it once or twice (Theme 1, View One, See More). Even for participants who describe more deliberate engagement with pro-ED videos, they still present themselves as powerless to subsequently shift out of the echo chamber of ED content that the algorithm creates for them (Theme 2, Morbid Curiosity).\u003c/p\u003e\u003cp\u003eOverall, participants describe engaging with a platform that they perceive to be harmful and largely beyond their control, but which they may nevertheless feel compelled to participate in whether out of \u0026lsquo;morbid curiosity\u0026rsquo; towards the content it provides, or more conventional peer pressure to participate in a media environment that is highly popular among their demographic.\u003c/p\u003e\u003cp\u003eThe way in which users articulate their relationship to TikTok\u0026rsquo;s algorithm reveals its particular potency and potential for harm; the participants express that they engage with TikTok in full knowledge that the algorithm will use even a one-time interest in ED-content and \u0026lsquo;feed off it\u0026rsquo;. This means that the control over content is often out of their hands and content-delivery has the potential to spiral out of control. We have seen that this can be regarding the quantity of content, i.e. the algorithm provides much more of the same content than initially asked for, or regarding the quality of the content, i.e. the algorithm moves from presenting ED-related content that is initially helpful to that which is unhelpful or even harmful. A combination of both is also possible.\u003c/p\u003e\u003cp\u003eThe different forms of personification attributed to the algorithm are striking in the extracts. They highlight the agency that users attribute to it as an entity that takes over and gains more and more control while the user becomes increasingly powerless, trapped and vulnerable \u0026ndash; they have \u0026lsquo;fallen down the rabbit hole\u0026rsquo;, as one participant puts it. In addition, the metaphor of \u0026lsquo;feeding off\u0026rsquo; something or someone, like a leech, highlights both the difficulty of shaking off this entity, and the notion of becoming weaker while it grows stronger. Finally, the expression \u0026lsquo;you can try and say not interested, but it \u0026ndash; it\u0026rsquo;s [...] working against you\u0026rsquo; resonates uncomfortably with notions of physical and emotional violation \u0026ndash; the user\u0026rsquo;s \u0026lsquo;not interested\u0026rsquo;, requesting a stop of activities, is neither registered nor respected. It is the complexity of this \u0026lsquo;relationship\u0026rsquo; with the algorithm that needs to be considered when evaluating the feelings expressed by young people with EDs around their engagement with this highly popular platform that plays such an important part in the lives of their peers. Participants express their engagement with ED-content on TikTok as something \u0026lsquo;they shouldn\u0026rsquo;t do\u0026rsquo;, something they recognise as not good for them and potentially harmful, yet also as something they feel strongly attracted to. They direct resulting feelings of guilt or blame about this engagement at themselves, and not directly at the platform. In addition, close analysis shows that users express the dynamic of these feelings not as predominantly caused by their interest in online ED-content \u003cem\u003eper se\u003c/em\u003e but regarding their engagement with the algorithm \u0026ndash; in full knowledge of its workings. This knowledge does not make them less vulnerable to its unhelpful mechanisms, though, especially when the socio-cultural role as well as information and entertainment value of this platform is so high among young people (McCashin and Murphy, 2023).\u003c/p\u003e\u003cp\u003eOur research also suggests that some of the limited strategies young people have available to them to avoid unhelpful content on TikTok, such as the \u0026ldquo;not interested\u0026rdquo; button, may be less effective for those who are in the most vulnerable state of their ED, because \u0026lsquo;morbid curiosity\u0026rsquo; leads them to watch the videos that appear on their FYP, click through to the accounts posting this content, or go actively searching for photos that they find disturbing. The YP interviewed for this study suggested they had to be in a particular mindset to be able to use some of the functions of the app available to them (e.g. muting, clicking \u0026ldquo;not interested\u0026rdquo;) \u0026ndash; a mindset that enables them to overcome the temptation to view content they find unhelpful or harmful. Similarly, other YP indicated that the TikTok algorithm was in some ways a blunt instrument that could not distinguish between pro-recovery and pro-ED content, and therefore showed potentially unhelpful content to those who did not search for it. Together, these findings highlight both the necessity of adding nuances to the TikTok algorithm so that it can distinguish between helpful and potentially harmful content and improving the functionality of existing measures so that it can support vulnerable users.\u003c/p\u003e\u003cp\u003eThis study has some limitations that are important to consider: namely, that all the participants whose extracts are analysed identified as female and typically had experience of AN rather than a range of diagnoses. Future qualitative research on the effect of TikTok algorithms and pro-ED content on those with lived experience must consider how different diagnoses might interact with the algorithm and pro-ED content in different ways, to produce different types of lived experience. It is critically important to also engage boys and young men in this research; while we did interview young men, none of the men spoke about TikTok. In retrospect, asking specifically about image-based platforms like TikTok (which appear to be more harmful to body image than text-based platforms (Mazzeo et al., 2024) would have provided greater insight from a more balanced gender perspective.\u003c/p\u003e\u003cp\u003eThat this study is the first to qualitatively consider the effect of ED content on TikTok among young people in the UK is an obvious strength. It supports existing quantitative research on TikTok algorithms and ED content (Griffith et al., 2024) while at the same time privileging the voices and experiences of those who navigate pro-ED content, TikTok algorithms, and their ED every day. The research also has the potential to enrich clinical understanding of the effects of TikTok on YP with EDs. McCashin and Murphy (2023) argue that there is limited understanding of the functionality of TikTok among mental health professionals; by providing an insight into the lived experience of TikTok algorithms for those with EDs, we hope to encourage clinicians to further consider the role of image-based platforms in ED prevention, treatment and care, particularly given the global reach and widespread youth use of these social media platforms.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis paper provides a lived experience perspective on what echo-chambers of ED content on TikTok can be like for YP.\u0026nbsp;Our findings have a number of important implications for policy, research, and practice. A key recommendation to regulatory bodies (e.g., OFCOM in the UK), and TikTok itself is to improve functions of the platform that make it safer for those who choose to engage with it – in other words, implement a harm-reduction policy (see Mazzeo et al., 2024). This includes implementing effective functionality: 1) effective ‘not interested’ buttons, 2) preventing unhelpful content being displayed on the back of consuming ‘helpful’ content. Greater transparency on how the algorithm determines what content to show to users is also required. Additionally, there should be consideration generally about approaches to ED-related content and how to manage/mitigate this. Improving understanding of the effects of image-based platforms like TikTok on YP with MH issues should include involvement with researchers, clinicians, patient-carer organisations (e.g. Beat in the UK) and YP themselves in changing policies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn terms of research implications, this paper has laid the groundwork for investigations into lived experiences of the TikTok algorithm, pro-ED content, and eating disorders. Future studies should take forward these findings by examining different populations, including boys and young men, people of colour, and people with ED diagnoses other than AN. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn terms of practice, raising awareness of the potentially detrimental effect of TikTok among young people themselves and among healthcare professionals and others working with young people will be a critical starting point. \u0026nbsp;Such awareness can support the development of informed, collaborative and supportive dialogue around social media use and its effects. \u0026nbsp;For example, two of the authors of the present paper collaborated with the UK national eating disorder charity Beat to facilitate the co-production of digital resources to support YP who post or engage with ED recovery-based social media in (a) posting sensitively and (b) viewing content mindfully (see\u0026nbsp;EDIFY, n.d.).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTargeted school-based interventions on increasing social media literacy have been demonstrated to be effective in the prevention and treatment of EDs (Fitzsimmons-Craft et al., 2020; Faccio et al., 2024; Schmidt et al., 2016) via facilitating discussions intended to help young people to critically evaluate the advantages and disadvantages of TikTok, and to navigate the site with awareness and intention.\u003c/p\u003e\n\u003cp\u003eSuch programmes might also be delivered via digital interventions. As Mazzeo et al., (2024) recognise, it is crucial for such interventions to be culturally sensitive and include girls and boys.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis paper presents novel research exploring the experiences of participants with lived experience of ED and their engagement with ED content on TikTok. Using linguistic analysis of narrative extracts from YP in the U.K., we found that participants’ descriptions of TikTok’s personalised algorithm suggest it may interact with, and in some cases exacerbate, ED-related behaviours and cognitions, leading users into harmful echo-chambers of ED content. These findings support the argument that image-based platforms such as TikTok should take greater responsibility for the role of algorithmic curation in the intensification of ED symptoms and enhance mechanisms that allow users to manage the content they encounter online.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u0026nbsp;\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval for this study was awarded by the University of Nottingham. All participants signed informed consent forms and were given the opportunity to pause or leave the study at any time, including after the interview.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent forms included consent for publication in academic and non-academic outputs, including written academic papers and oral presentations.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis work is supported by the Medical Research Council/Arts and Humanities Research Council/Economic and Social Research Council Adolescence, Mental Health and the Developing Mind initiative as part of the EDIFY programme (grant number MR/W002418/1)\u0026nbsp;\u0026nbsp;\u003cem\u003eAuthors’ contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eT.P.: concept of study, transcription of interviews, conducting interviews, analysis and interpretation of data, writing of main manuscript, contextualisation of findings, review of manuscript\u003c/p\u003e\n\u003cp\u003eH.B.: concept of study, analysis and interpretation of data, writing of main manuscript, contextualisation of findings, review of manuscript\u003c/p\u003e\n\u003cp\u003eD.H.: analysis and interpretation of data, writing of manuscript, contextualisation of findings, review of manuscript\u003c/p\u003e\n\u003cp\u003eJ.W: interpretation of data, contextualisation of findings, review of manuscript\u003c/p\u003e\n\u003cp\u003eB.İ.: contextualisation of findings, review of manuscript\u003c/p\u003e\n\u003cp\u003eU.S.: contextualisation of findings, review of manuscript\u003c/p\u003e\n\u003cp\u003eH.S.: contextualisation of findings, review of manuscript\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003cem\u003eAcknowledgments\u003c/em\u003e\u0026nbsp;We would like to thank all participants of the study for being open and sharing their stories with us.\u003c/p\u003e"},{"header":" References","content":"\u003col\u003e\n \u003cli\u003eArseniev-Koehler A, Lee H, McCormick T, Moreno MA. # Proana: Pro-eating disorder socialization on Twitter. 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Journal of Eating Disorders. 2023 Sep 26;11(1):170.\u003c/li\u003e\n \u003cli\u003eSteakley-Freeman DM, Jarvis-Creasey ZL, Wesselmann ED. What\u0026apos;s eating the internet? Content and perceived harm of pro-eating disorder websites. Eating Behaviors. 2015 Dec 1;19:139-43.\u003c/li\u003e\n \u003cli\u003eSteinberg L. Risk taking in adolescence: New perspectives from brain and behavioral science. Current Directions in Psychological Science. 2007 Apr;16(2):55-9.\u003c/li\u003e\n \u003cli\u003eValkenburg PM, Meier A, Beyens I. Social media use and its impact on adolescent mental health: An umbrella review of the evidence. Current Opinion in Psychology. 2022 Apr 1;44:58-68.\u003c/li\u003e\n \u003cli\u003eWall Street Journal. Inside TikTok\u0026rsquo;s Algorithm: A WSJ Video Investigation. Wall Street Journal. 2021.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWang V, Edwards S. Strangers are friends I haven\u0026apos;t met yet: a positive approach to young people\u0026apos;s use of social media. Journal of Youth Studies. 2016 Oct 20;19(9):1204-19.\u003c/li\u003e\n \u003cli\u003eZheng DX, Mulligan KM, Scott JF. TikTok and dermatology: an opportunity for public health engagement. Journal of the American Academy of Dermatology. 2021 Jul 1;85(1):e25-6.\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/li\u003e\n\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":"journal-of-eating-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joed","sideBox":"Learn more about [Journal of Eating Disorders](http://jeatdisord.biomedcentral.com)","snPcode":"40337","submissionUrl":"https://submission.nature.com/new-submission/40337/3","title":"Journal of Eating Disorders","twitterHandle":"@JEatDisord","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"TikTok, social media, eating disorders, algorithms, ED content, young people, qualitative thematic analysis","lastPublishedDoi":"10.21203/rs.3.rs-7283049/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7283049/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBackground\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTikTok’s algorithm is at the centre of its user experience. The platform, which allows users to create and consume short-form content, can enable young people (YP) to feel less alone when experiencing illnesses such as eating disorders (EDs) by encouraging them to build communities around mental health-related content. However, emerging research suggests TikTok’s algorithm might exacerbate ED symptoms by leading YP into spirals of ED content. This paper provides a lived experience perspective on what experiencing high volumes of ED content on TikTok’s For You Page (FYP) can be like for YP.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted 17 semi-structured interviews in which participants (UK-based, aged 16-25, with experience of disordered eating or an ED) described their experiences of using TikTok. We identified three themes that express how participants interact with ED content on TikTok: (1) View One, See More, (2) Morbid Curiosity, and (3) From Helpful to Unhelpful. Theme 1 describes viewing one unhelpful video and then being exposed to more of this content on the FYP. Theme 2 refers to young people’s descriptions of a strong impulse to view ED content when it surfaces on their FYP even if it is felt to be unhelpful. Theme 3 recounts young people’s experiences of viewing potentially helpful content (e.g., pro-recovery videos) and then being presented with pro-ED content on the FYP. Through a close linguistic analysis, we examine how participants talk about how they feel when viewing ED content on TikTok.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFindings\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants reported engaging regularly with ED content on TikTok. Their interactions with ED content show that the personalised nature of TikTok’s algorithm (which is sensitised to how long a user watches a video) can interact with and exacerbate some ED behaviours and psychologies, leading some YP into negative echo-chambers of ED content.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusion\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePlatforms should assume greater responsibility for their algorithms’ roles in intensifying ED symptoms and improve the efficacy of functions that help users control the content they see. A greater awareness of the role of TikTok in exacerbating ED thoughts and behaviours among mental health professionals is also necessary.\u003c/p\u003e","manuscriptTitle":"‘Falling down the rabbit hole’: a thematic analysis of young people’s views on TikTok algorithms and eating disorder content","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-25 11:57:58","doi":"10.21203/rs.3.rs-7283049/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-06T18:14:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T12:09:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-03T11:52:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323074338703795496033081111637393932878","date":"2025-09-15T09:19:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210684802668797043341871411630069279111","date":"2025-09-09T08:09:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-16T07:18:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-14T09:48:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-14T09:46:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Eating Disorders","date":"2025-08-03T11:24:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-eating-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joed","sideBox":"Learn more about [Journal of Eating Disorders](http://jeatdisord.biomedcentral.com)","snPcode":"40337","submissionUrl":"https://submission.nature.com/new-submission/40337/3","title":"Journal of Eating Disorders","twitterHandle":"@JEatDisord","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dcda4634-9028-4f75-8341-cc846ce8015e","owner":[],"postedDate":"August 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:04:08+00:00","versionOfRecord":{"articleIdentity":"rs-7283049","link":"https://doi.org/10.1186/s40337-025-01505-6","journal":{"identity":"journal-of-eating-disorders","isVorOnly":false,"title":"Journal of Eating Disorders"},"publishedOn":"2025-12-20 15:57:32","publishedOnDateReadable":"December 20th, 2025"},"versionCreatedAt":"2025-08-25 11:57:58","video":"","vorDoi":"10.1186/s40337-025-01505-6","vorDoiUrl":"https://doi.org/10.1186/s40337-025-01505-6","workflowStages":[]},"version":"v1","identity":"rs-7283049","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7283049","identity":"rs-7283049","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}