Eating Disorders and the Internet

Introduction

This article examines the rise of eating disorder websites. Eating disorders are most common in young women (both teenagers and young adults). As this demographic is a also known as a high-level user of the Internet, the proliferation of online eating disorder (ED) communities is of particular concern to ED support groups (ANAD 2006). Eating disorder communities are known a ‘Pro-Ana’, (pro-anorexic) and it is the term used both for their community and to describe an individual. While Pro-Ana is used to describe a person who is ‘pro-anorexic’, Bulimics use the term Pro-Mia (pro-bulimic). In this definition, people who identify as ‘Pro-Anorexic’ or ‘Pro-Bulimic’ embrace their eating disorder and generally consider it a lifestyle choice and not an illness or disorder. Pro-Ana communities are not generally limited to anorexics and generally include bulimics and other eating disorder sufferers within the community.

Pro-Ana websites represent themselves as online communities for those who are existing Anorexics and as such are not intended (as is frequently assumed), to lure non-sufferers into the illness. To the people who join them, they can be ‘a place’ that accepts their status without moral censure or social stigma as well as a site of advice, tips and support from fellow anorexics to help them become ‘better’ anorexics. While some of the Pro-Ana sites will also provide links to recovery and health sites, being ‘Pro-Ana’ symbolises a choice not to go into recovery. For pro-Anorexics, if you identify as ‘Pro-Ana’, then by definition you have chosen to live as an Anorexic or Bulimic at this point in time. The term ‘permarexic’ can also be used to describe those people who choose to live with their ED for the foreseeable future.

Eating Disorders Overview

Eating disorders (EDs) are characterised by a preoccupation with weight that results in severe disturbances in eating and subsequently other behaviours. Eating disorders embrace Anorexia, Bulimia and generic eating disorders such as purging, binging and night eating. The two most high profile eating disorders are Anorexia Nervosa and Bulimia Nervosa. Anorexia can be defined as essentially self-starvation, as this disorder involves a refusal to maintain a minimally normal body weight, a distorted body image and a fear of obesity or weight-gain (CEED 2006). People who have Anorexia generally develop unusual eating habits such as avoiding food and meals, picking out a few foods and eating them in small amounts, weighing their food, and counting the calories of everything they eat. Its incidence is increasing in the Western world and it has been described as one of the most lethal psychiatric disorders (Lucas et al 1999 in Hsu 2001). Sufferers of Bulimia are involved in repeated episodes of binge eating, followed by ways of trying to purge the food from the body to prevent expected weight gain by utilising methods such as self-induced vomiting, misuse of laxatives, enemas, or medications fasting, and/or excessive exercise to control weight (CEED 2006).

Common Aspects of a Pro-Ana Website

In order to research this article, I had to spend some time following dead links and doing diligent searching until I came across some functioning sites that catered to existing eating disorder sufferers. The nature of the public’s attitude towards many of these sites is such that they must change addresses constantly to avoid censure, or close voluntarily as a result of harassment and flaming, or are being arbitrarily closed down by their ISPs. The Pro-Ana communities manage to stay alive by frequently changing site addresses and communicating new web addresses within their community group.

Diaries: Many author’ of these websites offer personal accounts of their battle with anorexia or bulimia and how they struggle with starvation, how they feel about their body image and how they wrestle with taking control of themselves and their self-image. While the intention of some may well be to inspire weight loss among the website readers, the constant struggle and self loathing and self-castigation of the writers does not make Anorexia or Bulimia appear at all attractive. The diaries are also places to keep logs of food intake as well as ‘vent’ about unwelcome attempts by family members or friends to make the blogger recover from the disease, or the struggles she has in hiding her lack of eating from the rest of the world.

Discussion Forums: So that members can discuss their eating, their weight and their feelings. The forums act as both a source of dietary information and dieting support as well as somewhere to share their feelings and disclose in a non-judgemental environment. I observed the members to be very supportive and protective of each other.

Weight Loss Tools: Such BMI (Body mass index) calculators, homeopathic remedies and pharmaceutical pills. However, a search of Google on any given day will reveal similar information on many sites unrelated to Pro-Ana.

Food and Beverage Hints: Glycemic counters, calorie counters, lists of foods that are of negative calorie value, recipes for drinks and foods. In fact, all the things you can buy in the average women’s or girls’ magazine at your local newsagent.

A Recovery Room: a discussion forum specifically for recovering eating disorder sufferers. I only found this on a handful of sites.

The more militant Pro-Ana websites would typically contain some of these additional attributes:

Tips and Tricks: Mostly a list of methods, tricks and hints on how to make the process of starvation easier. It may give hints on hiding weight loss from relatives and how to pass weekly weigh-ins if parents make a teenager go to a nutritionist or counsellor. These lists may also contain explicit details on how to vomit after meals with the least amount of discomfort or on what to take to make the vomiting occur more quickly, as well as listing which foods are easiest to purge. This section will also contain tips for ways of avoiding eating and not getting caught (e.g. get up early and rinse cereal and milk around in a bowl and leave in the sink so your parents think you ate before them).

Thinspiration does exactly what the name implies: inspire readers to be thin, achieving this through pictures of unhealthily skinny models and movie stars. Favourites are pictures of young celebrity role models, including teen stars Lindsay Lohan, Mischa Barton and Nicole Ritchie. Thinspiration may also include articles on being fat, famous people’s height and weight, and triggering quotations such as ‘Nothing tastes as good as thin feels’, or ‘Food hinders progress’. Some Pro-Ana websites also encourage the use of a personal ‘Thinspiration book’ to always carry around as a means of remembrance when the person cannot be near a computer or they suggest the wearing of bracelets to signify the particular eating disorder and remind the wearer of her status (red for example signifies Anorexia and purple Bulilmia). The less militant sites do not contain ‘Thinspiration’ and may also ban tips and caution users that they will be banned if they give tips on vomiting, hiding their food, etc. In addition, they may also provide more information available on related areas of danger such as dental problems, heart disease and diabetes as potentially dangerous to ED sufferers.

Ana is my ‘Friend’

The Pro-Anorexia websites are able to provide eating disorder experts unprecedented insights into the world of their patients, revealing an obsession with the disease that may surprise even the most veteran eating disorder observers. For example in some cases, the younger sufferers can be observed to personalise their illness and naming her “Ana” (or “Mia” for girls with symptoms of bulimia), and some girls even worship her as a type of ‘deity’:

I tried to recover once & I gained so much weight so my savior mia came back to rescue me just when i needed it most (Anon Bulimic)

Pro-Ana Websites and Support

I found there to be degrees of Pro-Ana websites. While some did not acknowledge the possibility of recovery, others recognised that some sufferers wish to recover from their illness and as such focussed on support and community rather than dieting tips. In this way they provide an important forum for what can be both a marginalised and misunderstood segment of society. For young girls that suffer social stigma and misunderstanding of their eating disorder illness, simply being able to communicate with others who share their problems can be a huge relief:

I am an active bulimic, and I know I would be in serious trouble right now if I wasn’t in contact with other mias/anas through the sites I’ve been on. It’s really necessary to get your thoughts and feelings out somehow, and the sites are a great way to do that… (Anon Bulimic) I think that to take these sites away would be removing a valuable support network that we need to carry on, not with our disease, but with our lives. Most of these people cannot get support from family or friends, and these sites are where they go to talk about what they are going through freely, without being judged (Anon EdNOS Sufferer).

However it is precisely this aspect of community and belonging and how it interfaces with an eating disorder that worries some experts. Pro-Ana communities may in this instance be unintentionally encouraging the eating disorder as they provide an environment and opportunity to belong to the “eating disorder club”. Other experts concur, arguing that these ‘pro’ eating disorder websites are potentially deadly, because they normalise and affirm the very behaviour that defines the disease (Hayashi 2006, National Association of Anorexia Nervosa and Associated Disorders website, ANAD).

Summary

In a democratic society people use the Internet to form both healthy and questionable alliances, that is the nature of the medium. While some argue that Pro-Ana sites should be closed down, others question the ethics of censorship and argue simply banning them does not address the problem. To the people who are pro Anorexia or Bulimia, eating disorders are a lifestyle choice and the Pro-Ana websites are a support group to the people who use them. However many others, including family and friends of ED sufferers as well as medical and mental health professionals view the concept of a pro-eating disorder community as disturbing and dangerous, arguing Pro-Ana websites serve the function of normalising what is an illness, and ‘making it ok’ to be Anorexic. I believe this conjunction of the Internet and eating disorders is not well understood and is an area that requires further and ongoing research.

Glossary of Terms

Ana – Anorexia Nervosa Mia or Bella – Bulimia.

Pro-Anas and Pro-Mias – Bulimics and Anorexics who embrace their illness as a lifestyle, refusing to admit they are thin, and continuing to strive for weight-loss.

Permarexic – a person who has made the decision to live on only enough food as is necessary to maintain living and has adopted this as a life philosophy.

Rexie – a term used by Anorexics who believe they are living a controlled lifestyle choice as opposed to Anas, who Rexies believe are sick.

Thinspiration – quotes or pictures of very thin models or movie stars to act as inspiration to stay thin.

ED – eating disorder.

ED-NOS – Eating Disorder Not Otherwise Specified (vomiting, purging, binge eating).

Selected Bibliography

American Psychiatric Association: In: Diagnostic and Statistical Manual of Mental Disorders, (APA DSM-IV), (2000) Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association Press.

Anorexia Nervosa and Associated Eating Disorders. Inc.Website

Hsu, L.K. (2001). ‘Pathogenesis of Anorexia Nervosa’, Hong Kong Journal of Psychiatry, Vol 11, No. 3, pp 7-12.

MEDLINEplus: Eating Disorders website of the National Institutes of Health National Library of Medicine Website.

National Association of Anorexia Nervosa and Associated Disorders (ANAD) PO Box 7, Highland Park, IL 60035 USA, see their Website.

National Eating Disorders Association (NEDA) Website.

National Institute of Health Website: ‘Eating Disorders’, Pew Internet and American Life Project (2001) ‘Teenage Life Online: the rise of the Instant Message Generation and Internet’s Impact on Friendships and Family Relationships’.

The Centre for Excellence in Eating Disorders, Royal Children’s Hospital Victoria Australia (CEED) Website.

© Angela Lewis 2006