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Graphical abstract Access this article Similar content being viewed by others Data availability The data generated during the current study are available from the corresponding author upon reasonable request

"And it's sad because it's like, when you guys tell me, 'Oh, you used to look like a healthy weight,' like when you have an eating disorder, the word 'healthy' triggers me." "When people tell me that I look tiny, and I'm starting to look sick, for some reason, in my twisted brain, that gives me an endorphin rush."