1 - (IOP 33) The Culture of Living with an Eating Disorder in a Rural Region

Individuals living in rural regions have historically been understudied in mental health. This study aimed to qualitatively examine the cultural experience of living with an eating disorder in a rural region. Participants were rural adults with present or past eating disorders (N = 14). Participants completed a semi-structured clinical interview to confirm their eating disorder diagnoses. They then completed a qualitative interview where they were asked what the culture is like where they live regarding eating disorders. The interviews were transcribed and analyzed using thematic analysis, using description-focused coding. Three primary themes were identified: 1) the importance of the thin ideal (n = 13), 2) feeling ashamed of oneself (n = 9), and 3) experiencing weight stigma (n = 8). Within the importance of the thin ideal theme, participants identified messaging that appearance is more important than personality as a subtheme. They described being told that it is important to be thin and that other aspects of their lives were valued less than thinness. For another subtheme (sociocultural pressures), participants noted that pressures and messages to be thin came from multiple sources, but that the messages reflected broader “societal norms.” For the theme of feeling ashamed of oneself, participants identified feeling ashamed of their bodies, what they ate, how they acted, and for seeking or needing treatment. Participants also reported receiving comments from others that reinforced their feelings of shame. For the theme of experiencing weight stigma, participants identified feeling judged by others for their food and exercise choices because of how these choices may impact their weight. They described receiving rude comments about their bodies, being called mean names, and feeling pressure to avoid stereotypes about being “fat.” Participants also discussed feeling as if their eating disorder went undetected because of their body size. Results indicate that the cultural experience of having an eating disorder in a rural area is comprised of strongly communicated body norms, resulting in feeling isolated and ashamed. The combination of being understudied and having less access to resources highlights how more focus is needed to mitigate these challenging cultural experiences of having an eating disorder. Researchers can collaborate with rural community members, developing and testing digital interventions that increase community engagement and education to reduce cultural communication of weight stigma and the thin ideal.