Background: Obsessive-compulsive disorder (OCD) is a debilitating chronic anxiety disorder with low rates of remission. r/OCD is a peer support forum hosted by the Reddit website with over 180,000 users and 100‐200 new posts daily. While peer support has been associated with improved treatment adherence and outcomes, forums can also be an outlet for performing and accommodating compulsions (eg, seeking and receiving reassurance), which can ultimately exacerbate OCD. Objective: This study aims to inductively assess what types of content are posted on r/OCD, an online peer support forum for individuals with OCD, to better understand the prevalent topics, dynamics, and norms of such online communities. Methods: To describe the explicit content of the forum, 132 new posts with a total of 739 comments added to the subreddit within a 24-hour period from August 4, 2023, to August 5, 2023, were manually downloaded and coded using inductive thematic analysis. Though posts beyond the first 24 hours were downloaded, saturation of ideas was observed after the first 110 posts, and thus, no posts after the first 24 hours were included in the analysis. Through inductive thematic analysis, codes were organized into overarching themes. Results: Four main themes emerged during analysis: (1) validating OCD symptoms (n=69 total posts and comments), (2) connecting with peers with similar OCD themes (n=512), (3) coping with symptoms (n=280), and (4) sharing treatment experiences and advice (n=118). Many posts involved users describing their symptoms, questioning if a particular symptom was OCD, and asking other users if they had similar experiences. Users frequently categorized their OCD into subtypes using abbreviations (eg, “ROCD” [relationship OCD]) to seek others with similar experiences. A minority of posts solicited and provided advice on therapy and medication. Users were supportive and encouraging of each other’s recovery journeys. Conclusions: Online peer support forum users demonstrated substantial knowledge of OCD and treatments; these forums enable users to receive social support and exchange helpful information and peer experiences related to seeking medical treatment. However, many users use the platform to connect with others experiencing similar subtypes of OCD or to seek confirmation that their symptoms are OCD, which is promoted by community norms and may suggest they are reassurance-seeking. Close moderation by health care professionals and restricting detailed sharing of OCD symptoms to prevent reassurance-seeking may be important for ensuring a net positive impact of online peer support forums for OCD. In addition, clinicians should consider if their patients may be reassurance-seeking on this and similar OCD forums, given their popularity. Future studies should conduct interviews with users and investigate patterns of user ability to further understand the potential harms and benefits of online peer support forums.

This subreddit analysis characterizes the body dissatisfaction and desire to eliminate gendered physical characteristics that transgender and gender diverse (TGD) people with eating disorders experience. Many on the subreddit who were motivated to recover already had a clear understanding of interactions between their gender identity–related desires and their disordered eating, but were faced with unresponsive providers.

Background: Transgender and gender diverse people often turn to online platforms for information and support regarding gender-affirming hormone therapy (GAHT); however, analysis of this social media content remains scarce. Objective: We characterized GAHT-related videos on TikTok to highlight the implications relevant to GAHT prescribers. Methods: We used a web scraper to identify TikTok videos posted under the hashtags #genderaffirminghormonetherapy and #genderaffirminghormones as of November 2023. We identified recurrent themes via qualitative content analysis and assessed health education videos with the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) scale and a modified Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test. Results: Out of 69 videos extracted, 71% (49/69) were created by GAHT users, 24.6% (17/69) were created by health care workers, and 21.7% (15/69) were created to provide health education. Themes included physical changes on testosterone, GAHT access, and combating misinformation and stigma surrounding GAHT. Health education videos scored highly on PEMAT-A/V items assessing understandability (mean 88.3%, SD 11.3%) and lower on actionability (mean 60.0%, SD 45.8%). On the CRAAP test, videos scored highly on the relevance, authority, and purpose domains but lower on the currency and accuracy domains. Conclusions: Discussions of GAHT on TikTok build community among transgender and gender diverse users, provide a platform for digital activism and resistance against legislation that limits GAHT access, and foster patient-provider dialogue. Educational videos are highly understandable and are created by reliable sources, but they vary in terms of currency and quality of supporting evidence, and they lack in actionability.

Background: Scarring has been shown to have adverse health effects on marginalized patient groups. However, experiences of scarring among transgender and gender diverse (TGD) people have not yet been thoroughly characterized. Objective: This study aimed to investigate the impacts of scarring related to gender-affirming care and other causes among TGD people. Methods: Anonymous data were extracted from Reddit, a popular online platform organized into “subreddit” groups based on identities and interests. A combined total of 604 posts and comments that explicitly reference physical scarring were extracted from r/FtM, a subreddit for transmasculine people (449 posts and comments) and r/MtF, a subreddit for transfeminine people (155 posts and comments). Applying inductive thematic analysis, all posts and comments were coded and codes were sorted into overarching themes.  Results: Among the 604 posts and comments, the scars most discussed were secondary to gender-affirming care procedures, including mastectomy (n=338 posts and comments), hormone administration (n=102 posts and comments), and hair removal (n=38 posts and comments). Nongender-affirming care-related scars, such as those due to self-harm (n=43 posts and comments), were discussed less often. A total of five overarching themes emerged through thematic analysis: (1) concerns about physical outcomes related to scarring; (2) psychological distress related to scarring; (3) societal perceptions of scarring; (4) strategies to prevent, conceal, and minimize scarring; and (5) positive experiences with scarring. Conclusions: For TGD people, scar complications, visibility, and permanence represent major concerns. While many TGD people ultimately accept scarring as an unavoidable consequence, scarring both related and unrelated to gender-affirming care can present a significant psychosocial stressor for TGD people. Scarring can result in physical health complications, gender dysphoria, and negative body image; visible scarring is also a barrier for TGD people who wish to blend into society. Clinicians should improve communication regarding scarring outcomes and scar-care procedures. Future research should focus on the development of scar prevention, care, and reduction techniques for TGD people.

Asian American sexual and gender diverse youth experience bias-based stressors rooted in stereotypes and forms of oppression, which can contribute to coping behaviors like alcohol use. Few studies examine lifetime alcohol use with a focus on understanding heterogeneity within Asian American adolescents. The analytic sample included Asian American youth in 9^th through 12^th grade (N = 86,799) who completed the 2017-2019 California Healthy Kids Survey, a statewide, school-based survey. Exhaustive Chi-square automatic interaction detection was conducted using SPSS. Variables included exposure to sexual orientation and gender identity-based (SOGI) and race-based bullying and different social identities (ethnic, sexual, and gender identities and sex assigned at birth). Past-year SOGI-based bullying was reported by 11.2% of students and race-based bullying was reported by 18.8% of students. 19.6% of students indicated lifetime alcohol use, with higher rates among those in older grades (13.1% 9^th grade to 31.8% 12^th grade). Lowest lifetime alcohol use prevalence were among monoracial Asian American youth who were not the targets of bias-based bullying, while highest lifetime alcohol use rates were among youth identifying as multiracial and/or with a minoritized sexual orientation and experiencing bias-based bullying. Findings suggest bias-based victimization may lead youth to cope or attempt to fit in through alcohol use. Bisexual and multiracial youth, who are often marginalized from monoracial and monosexual communities also had high lifetime alcohol use prevalence. Future research should identify intersectionality-informed strategies to address the nuanced bias-based bullying experiences of Asian American sexual and gender diverse youth, particularly in school settings.

To elucidate the complex relationship between spirituality and obsessive-compulsive disorder (OCD), we performed a qualitative analysis of messages (n=225) referencing spiritualities in r/OCD, a public online peer support forum for people with OCD with over 250,000 users; two central themes emerged: (1) influence of spirituality on OCD symptom manifestation and (2) impact of OCD on relationship with spirituality.