# Cyberbullying and Problematic Internet Use as Correlates of Eating-Disorder Symptomatology and Health-Related Quality of Life in Women Under Specialized Care

## TL;DR

Cyberbullying and excessive internet use are linked in women with eating disorders, but their impact on health-related quality of life remains unclear.

## Contribution

This study explores how cyberbullying and problematic internet use correlate with health outcomes in women receiving eating disorder treatment.

## Key findings

- Cyberbullying exposure is strongly correlated with problematic internet and social media use.
- Participants with comorbid physical or mental health conditions report lower health-related quality of life.
- Adjusted models show small and imprecise associations between digital stressors and health-related quality of life.

## Abstract

What are the main findings?
Cyberbullying exposure was strongly correlated with problematic online use (IAT/BFAS) in women receiving specialized outpatient eating-disorder care.Participants with comorbid physical or mental health conditions reported lower HRQoL (EQ-5D index and EQ-VAS) in bivariate analyses.In exploratory adjusted models predicting EQ-5D, estimates for cyberbullying exposure, problematic internet use, and eating-disorder symptom severity were small and imprecise, supporting cautious interpretation.

Cyberbullying exposure was strongly correlated with problematic online use (IAT/BFAS) in women receiving specialized outpatient eating-disorder care.

Participants with comorbid physical or mental health conditions reported lower HRQoL (EQ-5D index and EQ-VAS) in bivariate analyses.

In exploratory adjusted models predicting EQ-5D, estimates for cyberbullying exposure, problematic internet use, and eating-disorder symptom severity were small and imprecise, supporting cautious interpretation.

What are the implications of the main findings?
Digital interpersonal stressors may be relevant correlates of patient-reported wellbeing in women receiving eating-disorder treatment, but the present data do not support practice-directing conclusions.Prospective and intervention studies are needed to test whether assessing digital experiences improves risk stratification and whether targeting online stressors yields meaningful gains in HRQoL.

Digital interpersonal stressors may be relevant correlates of patient-reported wellbeing in women receiving eating-disorder treatment, but the present data do not support practice-directing conclusions.

Prospective and intervention studies are needed to test whether assessing digital experiences improves risk stratification and whether targeting online stressors yields meaningful gains in HRQoL.

Background/Objectives: Digital environments have intensified exposure to interpersonal stressors and appearance-related evaluation, raising concerns about cyberbullying and problematic internet use among women with eating disorders (EDs). This study examined whether cyberbullying exposure and problematic online use are associated with health-related quality of life in women receiving specialized outpatient care for eating disorders in Spain. Methods: We conducted a cross-sectional analysis of baseline data collected between 2018 and 2019 from a clinical cohort of 124 women in specialized ED treatment. ED symptoms were assessed using the SCOFF and the Bulimic Investigatory Test, Edinburgh (BITE). Problematic online use was measured with the Internet Addiction Test (IAT) and the Bergen Facebook Addiction Scale (BFAS), and cyberbullying exposure was summarized using a composite index. HRQoL was assessed with the EQ-5D index and visual analogue scale (EQ-VAS). Associations were examined using correlation analyses, group comparisons, and exploratory multiple linear regression models adjusting for age, body mass index (BMI), diagnosis, and comorbidity. Results: Cyberbullying exposure was strongly positively correlated with problematic internet and social media use (IAT and BFAS). Its bivariate associations with ED symptom measures were small and not statistically significant. Participants with physical or mental health comorbidities reported lower HRQoL on both the EQ-5D index and EQ-VAS scores (p < 0.01). In the exploratory adjusted regression model predicting EQ-5D, coefficients for cyberbullying exposure, IAT, and BITE severity were small and imprecisely estimated, whereas diagnosis category showed between-group differences (with the “other ED” category reporting lower EQ-5D scores relative to the reference group). The overall model explained approximately 26.7% of the variance in EQ-5D (adjusted R2 = 0.22). Conclusions: In this clinical sample, digital-use measures co-occurred strongly with one another, and comorbidity was associated with poorer HRQoL at the bivariate level. In exploratory adjusted models, estimated associations of cyberbullying and problematic online use with HRQoL were imprecise, supporting cautious interpretation. Prospective and intervention studies are needed to determine whether digital interpersonal stressors contribute to HRQoL trajectories in women receiving specialized ED care and whether targeting these stressors improves patient-reported outcomes.