Although the Internet has many benefits, negative effects emerged from concentration on body image, weight, and comparisons with the ‘thin ideal.’
One area often overlooked in treatment is the time eating disorders patients spend on the Internet, according to a group of Israeli researchers (Front Psychol. 2018; 9:2128. d/fpsyg.2018.02128. doi 10.3389). And, the social interactions online can have positive and negative effects; patients can gain a sense of connectedness but also face comparing themselves unfavorably to the “thin ideal.”
Dr. Rachel Bachner-Melman and colleagues at Soroka University Medical Center, Beersheba, Israel, compared the scope, Internet use patterns, and degree of online need satisfaction of girls and women with and without a lifetime eating disorder diagnosis. The study group included 122 females 12 to 30 years of age; 53 had an eating disorder and were recruited from a hospital-based treatment program, and 69 age-matched controls with no current or prior eating disorder who were recruited from social media sites. All participants completed questionnaires that assessed disordered eating, body image, positive and negative affect, general distress and life satisfaction, and also completed an online survey about their Internet use, how often they watched and posted pictures and videos, online friendships and social comparisons, and their mood after leaving the Internet.
Similar time spent online, but distinct differences 
Both study groups spent a mean of 6 1/2 hours online each day. However, those with eating disorders spent more of their online time visiting forums and reading blogs than did control group members. In fact, more than half of their time online was devoted to eating, weight, and body image, significantly more than control participants (56.7% versus 29.1%, respectively).
The group with eating disorders watched significantly more videos online than did controls. However, both groups were equally likely to view pictures posted by others, but those with lifetime diagnoses of eating disorders were less likely to post pictures of themselves and others online than were controls.
After being active online, as, for example, commenting, posting pictures and offering advice to others online, those with eating disorders reported feeling sadder than did control group members. There was, however, no significant difference between the groups in their experience of relief, fear of others’ reactions to their comments, and satisfaction from having contributed something positive to the sites.
The authors noted that the study results showed several negative aspects of Internet use by women with eating disorders, and areas that might be targeted in treatment. Women with eating disorders tended to use the Internet to focus on eating, weight, and body image. They also tended to have a higher ratio of online to offline friends, to compare their appearance to others’ online photos, and to leave the Internet with negative feelings. This pattern was also associated with the severity of symptoms, body dissatisfaction, negatively associated with satisfaction with life.
Suggestions
The researchers had several suggestions for clinicians treating patients who frequently use the Internet to visit forums and blogs. Use of the Internet should be a topic in therapy with people who have an eating disorder.  Parents can also be informed about Internet use and take a greater interest in the eating- and body image-related Internet options open to young people and to be alert for possible signs of negative effects.
While encouraging the sense of connectedness that patient feel with being online, clinicians can also help patients develop “real life” social skills, such as social problem-solving and better recognition of facial expressions. Patients can also be encouraged to create connections with healthy people around them, and to speak about their disorders, helping reduce the need to do so exclusively or mainly online.