# Private Yet Social: How LLM Chatbots Support and Challenge Eating Disorder Recovery

arXiv: https://arxiv.org/abs/2412.11656 · HTML: https://mlsanity.com/paper/2412.11656/

## Key facts

- Cited by 8 papers in the map (data through 14 Oct 2026).
- Builds on 27 of its 134 references that are in the map.
- First posted on arXiv 16 Dec 2024.

## Builds on (most cited first, 27 of 27)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Sequence to Sequence Learning with Neural Networks](https://mlsanity.com/paper/1409.3215/) (2014)
- [Recipes for building an open-domain chatbot](https://mlsanity.com/paper/2004.13637/) (2020)
- [TransferTransfo: A Transfer Learning Approach for Neural Network Based Conversational Agents](https://mlsanity.com/paper/1901.08149/) (2019)
- [Quantifying the Persona Effect in LLM Simulations](https://mlsanity.com/paper/2402.10811/) (2024)
- [MART: Improving LLM Safety with Multi-round Automatic Red-Teaming](https://mlsanity.com/paper/2311.07689/) (2023)
- [LLM Critics Help Catch LLM Bugs](https://mlsanity.com/paper/2407.00215/) (2024)
- [AI Transparency in the Age of LLMs: A Human-Centered Research Roadmap](https://mlsanity.com/paper/2306.01941/) (2023)
- [The Ethics of Advanced AI Assistants](https://mlsanity.com/paper/2404.16244/) (2024)
- [Understanding the Benefits and Challenges of Using Large Language Model-based Conversational Agents for Mental Well-being Support](https://mlsanity.com/paper/2307.15810/) (2023)
- [Mental-LLM: Leveraging Large Language Models for Mental Health Prediction via Online Text Data](https://mlsanity.com/paper/2307.14385/) (2023)
- [TrustAgent: Towards Safe and Trustworthy LLM-based Agents](https://mlsanity.com/paper/2402.01586/) (2024)
- ["It's a Fair Game", or Is It? Examining How Users Navigate Disclosure Risks and Benefits When Using LLM-Based Conversational Agents](https://mlsanity.com/paper/2309.11653/) (2023)
- [MindfulDiary: Harnessing Large Language Model to Support Psychiatric Patients' Journaling](https://mlsanity.com/paper/2310.05231/) (2023)
- [From plane crashes to algorithmic harm: applicability of safety engineering frameworks for responsible ML](https://mlsanity.com/paper/2210.03535/) (2022)
- [MedGPT: Medical Concept Prediction from Clinical Narratives](https://mlsanity.com/paper/2107.03134/) (2021)
- [LLM-based Conversational AI Therapist for Daily Functioning Screening and Psychotherapeutic Intervention via Everyday Smart Devices](https://mlsanity.com/paper/2403.10779/) (2024)
- [Can AI Relate: Testing Large Language Model Response for Mental Health Support](https://mlsanity.com/paper/2405.12021/) (2024)
- [Supporting Self-Reflection at Scale with Large Language Models: Insights from Randomized Field Experiments in Classrooms](https://mlsanity.com/paper/2406.07571/) (2024)
- [Understanding the Impact of Long-Term Memory on Self-Disclosure with Large Language Model-Driven Chatbots for Public Health Intervention](https://mlsanity.com/paper/2402.11353/) (2024)
- [Evaluating the Experience of LGBTQ+ People Using Large Language Model Based Chatbots for Mental Health Support](https://mlsanity.com/paper/2402.09260/) (2024)
- [Contextual AI Journaling: Integrating LLM and Time Series Behavioral Sensing Technology to Promote Self-Reflection and Well-being using the MindScape App](https://mlsanity.com/paper/2404.00487/) (2024)
- [Do You Trust ChatGPT? -- Perceived Credibility of Human and AI-Generated Content](https://mlsanity.com/paper/2309.02524/) (2023)
- [The Distressing Ads That Persist: Uncovering The Harms of Targeted Weight-Loss Ads Among Users with Histories of Disordered Eating](https://mlsanity.com/paper/2204.03200/) (2022)
- [A Survey of Personality, Persona, and Profile in Conversational Agents and Chatbots](https://mlsanity.com/paper/2401.00609/) (2023)
- [A Browser Extension for in-place Signaling and Assessment of Misinformation](https://mlsanity.com/paper/2403.11485/) (2024)

## Built on by (most cited first, 8 of 8)

- [From Symptoms to Systems: An Expert-Guided Approach to Understanding Risks of Generative AI for Eating Disorders](https://mlsanity.com/paper/2512.04843/) (2025)
- [Food Noise & False Safety: A Systematic Evaluation of How LLMs Fail to Adapt to Eating Disorder Queries with Clinician Feedback](https://mlsanity.com/paper/2606.02444/) (2026)
- [Collective Voice: Recovered-Peer Support Mediated by An LLM-Based Chatbot for Eating Disorder Recovery](https://mlsanity.com/paper/2509.15289/) (2025)
- [Lived Experience in Dialogue: Co-designing Personalization in Large Language Models to Support Youth Mental Well-being](https://mlsanity.com/paper/2511.05769/) (2025)
- [Structure Matters: Evaluating Multi-Agents Orchestration in Generative Therapeutic Chatbots](https://mlsanity.com/paper/2603.00774/) (2026)
- [Trust Stack for Mental Health AI: A Survey of Calibration across Human, Interaction, and AI Layers](https://mlsanity.com/paper/2604.20166/) (2026)
- [Psychological Influences of Conversational AI: Research and Design Directions for Reducing Harm and Promoting Well-Being](https://mlsanity.com/paper/2607.25057/) (2026)
- [Right Words, Wrong Moment: A Clinician-Grounded Analysis of Distress in 19,930 Conversations between Young People and ChatGPT](https://mlsanity.com/paper/2609.35953/) (2026)

## Abstract (arXiv)

Eating disorders (ED) are complex mental health conditions that require long-term management and support. Recent advancements in large language model (LLM)-based chatbots offer the potential to assist individuals in receiving immediate support. Yet, concerns remain about their reliability and safety in sensitive contexts such as ED. We explore the opportunities and potential harms of using LLM-based chatbots for ED recovery. We observe the interactions between 26 participants with ED and an LLM-based chatbot, WellnessBot, designed to support ED recovery, over 10 days. We discovered that our participants have felt empowered in recovery by discussing ED-related stories with the chatbot, which served as a personal yet social avenue. However, we also identified harmful chatbot responses, especially concerning individuals with ED, that went unnoticed partly due to participants' unquestioning trust in the chatbot's reliability. Based on these findings, we provide design implications for safe and effective LLM-based interventions in ED management.