Disturbing web trend: Online pro-anorexia sites

[David Baxter PhD]

Looking for "thinspiration": pro-anorexia movement flourishes online
Wed Jul 21, 2004
by Hayley Mick

VANCOUVER (CP) - Type "pro-ana" into any Internet search engine and you'll get a disturbing glimpse into a deadly obsession with thin.

There are websites with names like Beautiful Bones and Anorexic Web. Also "thinspiration" photo galleries of waif-thin models and famous celebrities with eating disorders like Mary-Kate Olsen and Karen Carpenter. And discussion groups where apple-only diets are earnestly promoted and members sign off with tags that include their body weight. The groups have their own lingo, like "laxies" for laxatives, "mia" for bulimia and "ana" for anorexic.

"I feel like a big fat whore, my stupid boyfriend drives me nuts with his encouraging me to eat. I keep bouncing back from over and under 90 (pounds), I just want to get to 80 already!!" writes a message board member.

This is the online world of "pro-ED" (for pro-eating disorders) - hundreds of websites and discussion groups created and used by people who say they have the disorders.

And according to health professionals and educators, it's a subculture so pervasive and under the radar that it's hijacking prevention and recovery efforts, and helping eating disorders to spread.

"They're looking for tricks of the trade and how to maintain the lowest weight possible without dying," says Lauren Goldhammer, a therapist at Bellwood Health Services in Toronto, which has a residential treatment program for people with eating disorders.

"They're starving. And how do they keep going? They need some more encouragement, and I think those websites help them in that sense."

But the online world means more than that, according to those who frequent it.

Nancy Tewfik spent four months monitoring pro-eating disorder message boards as a psychology student at the University of Toronto. She also interviewed 12 young women about why they spent time on them.

Some said the sites helped them combat loneliness and feelings of isolation. Others claimed they weren't doing anything wrong and their eating disorder was a "lifestyle choice."

Ultimately, she says, what they got from the groups was a circle of friends.

"It's people that understand them. It's people that accept them as they are," she says.

But many professionals worry that the Internet is making it easier than ever for people to swap techniques on how to starve themselves - and keep it hidden.

The websites range in tone from self-loathing to defiance - but there are many similarities: tips on how to lose weight, tricks for inducing vomiting, what foods purge the easiest, how to avoid detection, "thinspiration" photos and quotes and message boards.

At one site, there's a flurry of enthusiastic responses to the thin and thinner before-and-after pictures posted by a young woman calling herself AnorexicBeauty:

• "You're my thinspiration! How did you do it?" writes one.
  
  "Your collar bones are beautiful - nice job," says another. [/list:u]
  "It's an expression by people that are ill who are trying to find support and justification for their thinking and behaviour," says Merryl Bear, executive director of the National Eating Disorder Information Centre in Toronto.
  
  What's more, she says, it allows other vulnerable people to be sucked in.
  
  "It's pervasive, so kids actually don't have to go searching for negative stimuli or negative encouragement to engage in unhealthy food and weight behaviours," Bear says.
  
  As prevalent as the websites and message boards are, Goldhammer says the Internet almost never comes up in her group therapy sessions with recovering anorexics.
  
  "They don't want to bring it out into the light of day," she says, adding discussion on Internet issues is also a rarity in academic literature about eating disorders.
  
  The Internet's shroud of anonymity is one reason the pro-ana and pro-mia movements have flourished. Eating disorders are secretive and isolating by nature, so the Internet provides instant access to information and people beyond all geographic borders.
  
  The slippery nature of the web also makes the pro-ED world almost impossible to control. After major media outlets publicized the issue in 2001, Internet giants like Yahoo began shutting many websites down. But they crop up elsewhere - and even today if you type "pro-ana" into a Yahoo group search you'll get dozens of hits.
  
  So, as for child pornography and digital music piracy, the solutions for cracking down on the online pro-eating disorder world are elusive.
  
  "For me, it doesn't make a big difference to close down one site because it will pop up somewhere else," says Bear. "What we need to do is to challenge the source of the issue."

 

[David Baxter PhD]

No, That's Sick

No, That's Sick
September 14, 2004
Washington Post

For three years, when Alison Devenny wanted weight loss tips, she turned to the Internet. But she didn't look for typical dieting Web sites. The George Washington University sophomore visited Web sites that encourage visitors to embrace anorexia and bulimia as "lifestyle choices" and provide instruction on how to do so.

The sites provide "thinspirational" pictures of extremely underweight women, menu suggestions, discussion boards and tips on topics including ways to overcome hunger pangs, such as doing household chores and drinking lemon water.

Despite attempts to encourage Internet service providers to close down such sites, many continue to exist. A recent Google search using the term "pro-anorexia" yielded 30,000-plus results. Many were links to pages by health authorities warning about the pro-anorexia movement, while others were links to sites no longer in operation. But many linked to live sites. A Google directory called "Pro-Anorexia" links to more than 50 sites.

Carol Day, director of health education services at Georgetown University and a member of the school's eating disorder treatment team, called the sites "dangerous and disturbing."

Experts say the sites can reinforce unhealthy behaviors, slow the recovery process and discourage people from seeking help.

"I think anyone who is working in the field of eating disorders realizes how unhealthy" the sites are, Day said.

"I always kind of knew that what I was doing was stupid," said Devenny, now 19, who has since begun treatment for multiple eating disorders. She used to visit the sites about twice a week, she said, picking up tips on how to avoid eating and how to keep her illness a secret from her family.

The terms "Ana" and "Mia" -- short for anorexia (a condition characterized by eating so little that one's health and life are at risk) and bulimia (overeating and then purging by vomiting or taking laxatives) -- are often used by those with eating disorders who don't want treatment.

Frequent visitors to these sites refer to themselves as "anas" and "mias" and say the sites offer a safe haven where they can talk, share advice and commiserate away from the harsh criticism of family, friends and other "outsiders."

The sites' creators are typically teenagers and young adults who have eating disorders. Many are directed at women, who experience eating disorders more often than men.

About 0.5 to 3.7 percent of women suffer from anorexia in their lifetimes, according to the National Institute of Mental Health (NIMH). About 1 to 4 percent are bulimic. NIMH estimates that about 2 to 5 percent of Americans experience binge eating disorder (characterized by excessive eating that occurs, on average, at least two days a week in a six-month period).

Those with eating disorders exhibit serious disturbances in eating behavior and feelings of extreme concern about body shape or weight, the NIMH says. Researchers are investigating how voluntary behaviors, such as eating different sizes of food portions, at some point develop into an eating disorder. Experts agree that eating disorders are not due to a failure of will but are treatable medical illnesses.

Eating disorders are often accompanied by depression, substance abuse and anxiety disorders. Common personality characteristics include excessive anxiety, perfectionism and low self esteem. Treatments include hospitalization or outpatient treatment, as well as psychotherapy, nutritional counseling, cognitive therapy, behavioral therapy and antidepressant medication, according to the Harvard Eating Disorders Center.

About half of people with anorexia or bulimia recover completely through treatment, according to the Harvard center. About 30 percent make a partial recovery, and 20 percent have no substantial improvement. The mortality rate for anorexia is about 5.6 percent per decade, according to NIMH. Cardiac arrest and suicide are common causes of death for anorexics. But "Anas" and "Mias" say they are not sick, don't need to be "fixed" and don't want sympathy. They develop creeds and post poetry and online diaries reciting their beliefs. They applaud one other for reaching low weights. Their message board conversations often turn to statistics: height, weight, measurements.

A site called Blue Dragon Fly sells red bracelets to encourage "solidarity" among pro-anas. "So you can go out into the world and not have to wonder, 'Is she or isn't she?' . . . You see the red bracelet, and you know," the site explains.

But it's the pro-eating disorder advice that many women say they seek on these sites. There are tips for the best foods to eat and vomit up later ("remember if it is hard to swallow it will be hard to 'unswallow,'" one site says) and how to cover up your eating disorder (tell friends and family you're sick or have already eaten, tips another site). A college sophomore from Alexandria diagnosed with bulimia and anorexia said tips from pro-eating disorder sites helped her go from 161 pounds to her current 74 pounds.

"At times I did gain back the weight, but I would always make a plea for help on the pro-ana" Web sites, she wrote in an e-mail responding to a reporter's question. She asked not to be identified by name, adding that although her family knows she has an eating disorder, they don't know -- and wouldn't approve of -- her visiting these sites. She called the sites "a tether to bring me back on track when I start to think about going into rehab or bingeing without purging."

Some Internet service providers shut the sites down in 2001 after the nonprofit National Eating Disorders Association (NEDA) and other groups complained that the sites contained content that could harm minors. Many sites disappeared briefly, only to reemerge later under different names and on different Internet domains.

Seattle-based NEDA has since changed strategies, opting to create increased awareness and education about eating disorders on the Web and elsewhere.

"There's the whole free speech issue" in trying to have sites removed from the Web, said NEDA chief executive officer Lynn Grefe. Unless sites encourage or reflect specific crimes, most Internet service providers have been reluctant to shut them down.

America Online, which has about 23 million U.S. subscribers, has removed several pro-eating disorder Web sites in the past few years under its policy prohibiting "material that defames, abuses, threatens, promotes or instigates physical harm or death to others, or oneself," according to company spokesman Andrew Weinstein. "Encouraging an eating disorder would fall into the category of promoting physical harm to others," Weinstein wrote in an e-mail.

Grefe said NEDA realized that its time was better spent getting the word out about eating disorders and treatments, rather than pushing to eliminate the sites. "We can't rid the world of these sites . . . but we can be more proactive in trying to get real information out to the public," Grefe said.

NEDA sets up booths at schools to educate students about eating disorders and available treatments, and it runs a confidential telephone help line. It also offers eating disorder information on its Web site.

Health professionals said people who think they may have eating disorders should seek medical treatment, rather than surf the Web for advice.

"I would prefer that individuals not access that particular door [pro-eating disorder sites] because I think there are dangers involved," said David B. Herzog, president of the Harvard Eating Disorders Center.

Most sites offer a disclaimer on their home pages: "If you are currently in recovery from an eating disorder or if you are offended or otherwise disturbed by the existence of pro-ana, I suggest you go no further," warns a site called The Thin Files. Others discourage visits by those under 18.

The Blue Dragon Fly site takes a different approach. It acknowledges that eating disorders are mental illnesses. Still, discussions on its forums resemble those on other sites. But its creator warns on the home page: "Tips are to give you fresh ideas on how to stay on track so that you don't fall into a depression and kill yourself -- not to teach you how to 'not eat.'"

Some site visitors are harshly critical of former anas and mias who have sought treatment. The creator of a site called Help Me Ana explains on her home page that she has gotten treatment and will no longer be maintaining the site. Some visitors signed her site's guest book and wished her well, but others accused her of turning against them.

"HAH recovery, u r jus like the rest of them, u tune in & cop out wen it gets tough, i hope ur happy wen u get fat & hideous. Ana loved u & ur rejecting her 2 join the obesians," read a message signed by someone using the screen name "witchyfingers."

"I feel kind of bad for girls who go into it with a little less maturity and buy into everything they read," said Devenny, an international studies major from New Jersey who is now in therapy and on medication for anorexia, bulimia and binge-eating disorder.

"I think it's dangerous, especially in the wrong hands. . . . This is a life and death matter for a lot of people."

Resources
To reach the National Eating Disorders Association's confidential help line, call 800-931-2237.

For more information about eating disorders and treatments, visit www.nationaleatingdisorders.org/p.asp?WebPage_ID37, www.hedc.org, or www.nimh.nih.gov/publicat/eatingdisorders.cfm.