title: Experiences of using pro-eating disorder websites: a qualitative study with service users in NHS eating disorder services.
abstract: OBJECTIVE
  Previous research into the impact of pro-eating disorder (pro-ED) websites has predominantly been undertaken using experimental and survey designs. Studies have used both clinical and non-clinical (college student) samples. The present study aimed to explore the underlying functions and processes related to the access and continued use of pro-ED websites within a clinical eating disorder population using a qualitative research design.
  
  
  METHODS
  Participants were recruited through NHS community mental health teams and specialist eating disorder services within South Wales, UK. Face-to-face semi-structured interviews were conducted with seven adult women in treatment for an eating disorder who had disclosed current or historic use of pro-ED websites. Interviewees ranged in age from 20 to 40 years (M = 31.2; SD = 7.8). Constructivist Grounded Theory was used to analyse interview transcripts.
  
  
  RESULTS
  Five key themes were identified within the data, namely fear; ambivalence; social comparisons; shame; and pro-ED websites maintaining eating disordered behaviour. The pro-ED websites appeared to offer a sense of support, validation and reassurance to those in the midst of an eating disorder, whilst simultaneously reinforcing and maintaining eating disordered behaviour.
  
  
  CONCLUSIONS
  Themes are discussed in relation to implications and recommendations for clinical practice. Limitations of the present study and suggestions for future research are also outlined.
authors.affiliation: Caswell Clinic, Bridgend, CF31 4LN, UK. leigh.gale@wales.nhs.uk.
authors.forename: Leigh
authors.initials: L
authors.lastname: Gale
authors.affiliation: South Wales Doctoral Programme in Clinical Psychology, 11th Floor, Tower Building, Park Place, Cardiff, CF10 3AT, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Channon
authors.affiliation: Talygarn, County Hospital, Pontypool, Torfaen, NP4 5YA, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Larner
authors.affiliation: Caerphilly CMHT, Old School Building, Mill Road, Caerphilly, CF83 3FD, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: James
mesh_terms: D000328:Adult; D001828:Body Image; D001068:Feeding and Eating Disorders / Q000523:psychology*; D005260:Female; D006801:Humans; D020407:Internet; D036301:Qualitative Research; D012054:Reinforcement, Psychology; D061108:Social Media; D006113:United Kingdom; D055815:Young Adult
keywords: Pro-ana; Pro-anorexia websites; Pro-eating disorder websites; Pro-mia; Thinspiration