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The objective of this study is to investigate the behaviour in the internet of patients suffering from anorexia and bulimia nervosa. Particularly, the communicative usage of the internet as well as the quality of relationships and social support received in discussion boards and social networks are studied. In addition, this study aims to investigate the influence of discussion boards on the course of the disease and the level of awareness and usage of pro-anorectic discussion boards witch declare eating disorders not as a disease but as lifestyle. Furthermore the acceptability of internetbased therapies in the sense of e-mental health is analyzed. E-mental health describes the usage of new technologies like the internet or mobile phones in the field of prevention, early detection, therapy and relapse prevention of psychiatric disorders.
Methods: Data was gathered by the use of anonymous completed questionnaires from 81 out- and inpatient participants aged 18 to 35 years old (mean 23,99 years ± 3,97 SD) suffering from anorexia and bulimia nervosa. Patients were recruited in 2012 throughout Germany and their answers were compared to answers from 81 controls. 93,8 % were female and 6,2 % male.
Results: There was no difference found in the weekly amount of usage of the internet and discussion boards between eating disordered patients and the control group. Principally internet is used for e-mails and search engines. Patients use the internet more for discussion boards (p = 0,030) and social networks (p = 0,019) than the control group does. Patients with eating disorders who use discussion boards behave more actively in discussion boards than the control group does (p = 0,004). They also visit discussion boards significantly more often because of emotional needs, particularly when they have negative feelings (p < 0,001) or to distract themselves from trouble (p = 0,001). Patients claim that discussion boards can have positive as well as negative impacts on the course of their disease. Pro-anorectic websites are known by half of the patients, whereas a fifth affirms to have habitually used these websites. Internetbased therapies are known by less than 20 % of the patients and there is a rather sceptical opinion about them. Participants relationships in discussion boards and social networks are seen as less important and relationships based outside of the virtual world are considered more important. However, patients with anorexia and bulimia nervosa who use discussion boards experience a significantly higher quality of interpersonal contact like comprehension, a sense of belonging and respect on the discussion boards in comparison to the control group (p < 0,001). They also claim to receive significantly more social support in discussion boards (p < 0,001) as well as strengthen personal and social competence such as self-esteem and openness than controls (p = 0,044).
Discussion: There are some promising results regarding e-mental health in the area of eating disorders. It appears that discussion boards are more important for patients with anorexia and bulimia nervosa than for controls. Patients use the internet more as a communicative medium and they receive more social support in discussion boards than the control group does. Nevertheless there is a limited meaningfulness of the results concerning discussion boards due to the small number of sample. With the help of a broader knowledge of the behaviour in the internet of patients with anorexia and bulimia nervosa therapies can be designed more efficiently. Future studies should investigate which discussion boards promote healthy lifestyles and which ones encourage eating disorders. Furthermore future research should focus on how e-mental health can be integrated effectively into the therapy of eating disorders.
Conclusion: The results of this study suggest that e-mental health could be a good complement to the current therapy for many patients suffering from anorexia and bulimia nervosa.