The prevalence of visiting pro-anorexia sites is non-trivial. The significant correlations between viewer ship of pro-Ana sites and predictors suggest a potential for negative impact of exposure to pro-Ana sites. This paper discuses the research and investigation that has been done regarding the relationship between frequent exposure and use of pro-eating disorder Web sites and the severity of disordered eating behaviors and quality of life impairment. Since 2006, the number of pro-anorexia and pro-bulimia Web sites has ballooned by 470 percent, according to Optenet, an information technology security company. Thus, today's adolescents' interest in using pro-Ana sites is skyrocketing.
The notion of embodiment in today's society reflects that the body has become everything. Research conducted by Eberhard in the 1990s, using in-depth interviews with young women who self-starved and binge-purged found conflicting imperatives between a search for selfhood (the body as a project of the unique self) and a quest for sainthood (goodness by denying or degrading the body) in constructions of young women's identities. Eberhard argues individuals still consider their bodies (as well as their lifestyles) as a last resort for their autonomy and their identity, which forms the basis of the concept of social and emotional capital as key ingredients of healthy outcomes. Eberhard argued that "the body has become a nothing . . . or maybe it is the other way around: the body has become everything." His notion of the human body as everything but nothing hinges on the notion of embodiment.
A whole lot of girls find solace in the notion that anxiety is now the norm. It is troubling that so many girls are using their sexuality in an instrumental way, in order to accomplish some other end such as raising their social status, but not as an expression of their own [feelings and desires].
Regarding eating disorders, In A CONVERSATION WITH KATE FILLION she says, "Only a minority of girls have diagnosable eating disorders, but so many girls in North America are obsessed with what they eat and how slender they are, or are not. So that girl who really does have anorexia has accomplished what all the other girls talk about but have never achieved. That becomes her defining sense of self: "I'm the really skinny girl, that's an accomplishment." It's not a cry for help- in fact; they don't want grown-ups to pay attention because they don't want someone to take that achievement, that identity, away from them. The pro-Ana websites [celebrating anorexia] that girls create promote the idea that skinny girls look good in any kind of clothes, and "I can live on mind power alone," and create a very unhealthy online community in which it's normal to be anorexic. These girls believe it's a lifestyle choice, not a pathology." It appears that these girls respond to anorexia with positive feelings.
Based on animal models of anorexia nervosa, altered activity patterns in the ventral striatal reward system in women with anorexia nervosa was predicted, depending on altered processing of disease-specific visual stimuli depicting a female body image with underweight, normal weight, and overweight canonical whole-body features according to standardized body mass indices.
Animal studies assessing mechanisms of self-starvation under conditions of stress and diet suggest a pivotal role for the mesolimbic reward system in the maintenance of core symptoms in anorexia nervosa, which is corroborated by initial empirical evidence in human studies. Activity in the ventral striatal system in response to disease-specific stimuli in women with acute anorexia nervosa was examined. Participants were 14 women with acute anorexia nervosa and 14 matched healthy comparison women who underwent functional magnetic resonance imaging (fMRI) during evaluation of visual stimuli depicting a female body with underweight, normal weight, and overweight canonical whole-body features according to standardized body mass indices. Participants were required to process each stimulus in a self-referring way. Ratings for each weight category were used as the control task. Behaviorally, women with anorexia nervosa provided significantly higher positive ratings in response to underweight stimuli than in response to normal-weight stimuli, while healthy comparison women showed greater preference for normal-weight stimuli relative to underweight stimuli. Functionally, ventral striatal activity demonstrated a highly significant group-by-stimulus interaction for underweight and normal-weight stimuli, in women with anorexia nervosa; activation was higher during processing of underweight stimuli compared with normal weight stimuli. The reverse pattern was observed in healthy comparison women. These findings are consistent with predictions in animal studies of the pivotal role of the human reward system in anorexia nervosa and thus support theories of starvation dependence in maintenance of the disorder.
The present results show that the ventral striatal reward system is differentially activated upon processing of disease-specific stimulation in patients with acute anorexia nervosa. These findings are in accordance with predictions derived from animal studies on the pivotal role of the human reward system. Thus, results support theories of starvation dependence accounting for the maintenance of anorexia nervosa, which may lead to an expansion of current concepts of intervention for the disorder.
In response to the content of online pro-Ana support groups: "If these sites make us uncomfortable, the focus at the public health level should be asking how we can reach and treat more people struggling with disordered eating, and how we as providers can become more comfortable with the difficult feelings that people with eating disorders feel," Rebecka Peebles said. "Right now, many patients are going to the Web to express those feelings, instead of handling them through traditional models of care, such as psychotherapy."
"Although pro-eating-disorder Web sites are often portrayed in a black-and-white manner, most of them exist on a continuum," [Rebecka Peebles] said. That is likely the result of the mixed feelings eating-disorder patients have about their disease, she added: "Many people with disordered eating behaviors have days when they want to get better, and days they have no interest in getting better. The Web sites reflect the individual characters of the people visiting them."
Nearly 80 percent of the sites had interactive features, 85 percent displayed "thinspiration" materials (such as photos of very thin models or celebrities) and 83 percent offered suggestions on how to engage in disordered eating behaviors. Yet most sites recognized that eating disorders are a disease, and more than a third included recovery information. Twenty-four percent of the Web sites had high perceived-harm scores (4 or 5 on a scale of 1 to 5); the rest of the sites received medium or low harm scores.
The paper conducted by Hopkins/Stanford researchers reports on 180 Web sites that were found using search terms such as "Pro-Ana," "Pro-Anorexia," "Pro-Bulimia" and "Thin and Support." The researchers evaluated each site's basic logistics; accessories such as interactive forums or calorie counters; themes (including control, success and perfection); "thinspiration" images, tips and techniques for weight loss; and recovery information. They assigned each site a "perceived harm" score based on their assessment of how harmful the site would be to users.
Clinicians who treat eating disorders and family members of eating-disorder patients need to be aware that the sites exist, are easy to access and can help reinforce disordered eating patterns, Peebles stated.
Content analyses provide systematic data on what is available and likely to be seen by users of pro-eating disorder Web sites. In addition there is a methodology to characterize the harmful nature of these sites by noting the features significantly associated with higher levels of perceived harm. Different methodologies must be employed to determine whether and how exposure to such material and media affects users. Research and investigation has been done regarding the relationship between frequent exposure and use of pro-eating disorder Web sites and the severity of disordered eating behaviors and quality of life impairment (R. Peebles et al., unpublished data, 2010).
Because technology is constantly advancing, these Web sites will evolve and change. Already, recent media reports have noted that pro-eating disorder sites now use more video and social networking approaches, and this interactivity is suspected to increase. To better understand how messages and potential harm are communicated through such media venues, researchers must continue to investigate both the messages an individual is exposed to and their impact. Although technological, political, and cultural challenges would be abundant, attempts could be made to regulate pro-eating disorder sites.
Discussions of media literacy and how photos can be altered so that subjects appear thinner were also included on 13%of the sites. Sites that described eating disorders as a disease showed a trend toward being more likely than sites that described eating disorders as a lifestyle choice to have any recovery-oriented material or links.
Sites with medium levels of perceived harm had similar content and were categorized by independent and trained reviewers as somewhat dangerous. Sites with high levels of perceived harm were considered dangerous or very dangerous, and the content featured on these sites could lead to immediate and life-threatening problems.
Unfortunately, the Internet offers a plethora of Web sites that describe, endorse, and support eating disorders. The features of pro-eating disorder Web sites have been examined and the messages to which users may be exposed. A systematic content analysis of 180 active Web sites was conducted, noting site logistics, site accessories, "thinspiration" material (images and prose intended to inspire weight loss), tips and tricks, recovery, themes, and perceived harm. Practically all (91%) of the Web sites were open to the public, and most (79%) had interactive features. A large majority (84%) offered pro-anorexia content, and 64% provided pro-bulimia content. Few sites focused on eating disorders as a lifestyle choice. Thinspiration material appeared on 85% of the sites, and 83% provided overt suggestions on how to engage in eating-disordered behaviors. Thirty-eight percent of the sites included recovery-oriented information or links. Common themes were success, control, perfection, and solidarity. Pro-eating disorder Web sites present graphic material to encourage, support, and motivate site users to continue their efforts with anorexia and bulimia. Thus, today's adolescents' interest in using pro-Ana sites is skyrocketing.
The objective of a study done by Kathleen Custersy & Jan Van den Bulck on Viewer ship of Pro-Anorexia Websites in Seventh, Ninth and Eleventh Graders was to examine the prevalence of visiting pro-anorexia websites by 13-, 15- and 17-year old adolescents and to explore correlates of visiting such websites and predictors of anorexia nervosa (AN).
The prevalence of visiting pro-anorexia sites is non-trivial and the significant correlations between viewer ship of pro-Ana sites and predictors suggest a potential for negative impact of exposure to pro-Ana sites. With some speculative remarks on the potential threat of the existence of pro-Ana sites to organized health care.
12.6% of girls and 5.9% of boys had visited such websites. In girls, visiting pro-anorexia websites was associated with a higher drive for thinness, worse perception of appearance and more perfectionism.
While there was no significant trend for grades as a whole participants in the eleventh grade were significantly more likely to have visited pro-Ana websites than those in the seventh grade had. Girls were 3.1 times more likely to have visited pro-Ana websites than boys had. Participants who felt that the existence of pro-Ana websites was bad or somewhat bad were 2.9 times more likely to have visited such websites compared to participants who saw the existence of pro- Ana sites as very bad.
Anorexia and bulimia affect about 1 and 2 percent of young women, respectively, as well as smaller numbers of males.
In the context of eating disorder related websites, Wilson et al. s. (2006) suggests that body talk orients to sub-cultural norms. For example, on the pro-Ana site body talk functioned to construct the poster's body as very thin. The analysis resonates with finding that some patients at eating disorder clinics learn eating disorder related techniques from recover sites. The absence of gender in the analysis is noted. Although all the posters claimed to be female, none of the extracts we examined on body talk specifically mentioned gender, making their talk strangely gender neutral. Evidence of the types of feminine identities highlighted by Day and Keys (2008) was not found.
In a recent study, data collection from two sites took place over a 3-day period from 24 December to 26 December, inclusive. During the data collection period there were 105 contributions by 46 different posters on the recovery site and 107 contributions by 24 posters on the pro-Ana site. The mean number of posts per person was 2.52 for the recovery site and 4.48 for the pro-Ana site. Even though 10 percent of people in America with eating disorders are male, the public face of eating disorders continues to be female. All posts were by females, living predominantly in the US, UK or Australia.
Differences between patterns of talk on the two sites were thus more distinct in body talk on embodied experiences. In the recovery site, the posters described a difficult and tentative move away from behaviors and thoughts associated with their eating disorder. This was supported by the other members on the site and thus, a construction of eating disorders as problems were reinforced. In the pro-Ana site, the problematic bodily experiences were celebrated as measures of success. This pattern of talk suggests that the posters on the pro-Ana site did not necessarily join with fully formed anorexic identities. Instead, through interaction with others an understanding of themselves as anorexic was developed. This process is conceptualized with the term 'dynamic replication' in which understandings of anorexia was constantly developed through sharing and reframing personal experiences. For example, a poster received a new form of understanding about her hair loss: it is not 'really scary' as she first constructed it, but a sign she is 'doing all the right things'.
Despite these patterns of apparent uniformity, the content on pro-ana/mia websites can differ. Understanding patterns of talk on these different sites can inform our understanding of their differences and similarities. Previous work has suggested that talk on recovery and pro-Ana sites may not reflect apparent oppositional ideologies (Giles, 2006; Wilson et al., 2006). Body-talk on one pro-Ana and one recovery web site was examined to explore this contradiction, specifically to discover how identities associated with weight and body management are negotiated, managed and developed within the context of online eating 'disorder' related self help/lifestyle websites.
To better understand information shared on these sites, and aide clinicians in identification, treatment, and prevention of anorexia a content analysis study was conducted by The International Journal of Eating Disorders on the "Tips and Tricks" section of pro-Ana websites. Most "Tips and Tricks" are directed at dieting/restricting calories (28.6%) and distraction (14.0%). Most disturbing, 11% of comments were directed at lying and concealing symptoms.
Not surprisingly, the most frequent theme was Dieting and Calorie Restriction, with 28.4% of the themes falling into this category. Example comments include: "Pick one food for the day like an apple. Cut it into eight slices. Eat two slices at breakfast, two at lunch, two at dinner, and you will have two left for a snack! This way your body thinks it is eating four times that day, but in reality you have only had one apple." And, "Focus especially on the first three bites. After that, the excitement of eating will begin to slowly subside, and you will probably be content with a smaller portion. If you do not feel comfortable not eating too much, eat only a hard boiled egg, an apple, and a glass of water. It will fill you up all day."
Exposure to real life scenarios can oftentimes be inspiring and helpful in overcoming anorexia. ThinandbeautifuL.com is the story of Maddie, a high school student who decides to lose weight. The story spans several years and shows Maddie's decent from dieter to obsessive anorexic. The book switches back and forth between Maddie in the hospital and her 'memoir', which tells the story of her eating disorder and is explained as a technique of writing by stating that it's her characters rehab treatment. During her decent, Maddie is a participant in message boards on a website "Thin and Beautiful' and part of her recovery focuses on her relationships with her fellow anorexics on this board and learning to detach from their support and influence.
This novel is quite realistic in detailing how an individual can travel from wanting to lose a few pounds to becoming quite ill in her pursuit of the perfect body. The incorporation of technology and the 'pro-Ana' and 'pro-mia' sites that have cropped up in the past years has been done quite sensitively - but cautiously. Shaw has purchased the domain, which is indicated by her title and uses it as a blog that promotes healthy thinking and eating. Continued in her sensitive treatment of eating disorders, Shaw gives us enough information about Maddie to know her story without giving too much information and unintentionally becoming 'thinspiration'. For example, we know of a weight for Maddie, but not of her beginning or her end weight, ensuring that she has not given other potential Maddies a goal to try to imitate. The author indicates in her biography that she is an eating disorder survivor, so the reader can wonder how much this novel follows her story. However, it is that personal past, coupled with her years of teaching that gives Shaw a sensitive outlook upon her topic and from that, the ability write a very true to life story. The end of the novel leaves the reader with feelings of hope and hope that Maddie and all the real life Maddies - will make it after all.
Also in the media, is a short film highlighting the contrasting views on pro/anti-Ana advocates. This film discusses cultural stereotypes pertaining to anorexia along with legislation standpoints on the matter. A popular belief is that French women don't get fat. Nobody takes this more seriously than the young women of France who live with anorexia and read and write "pro-Ana" blogs. National Assembly legislator Valerie Boyer is so disturbed by the trend, she proposed a bill to ban and punish the people behind these online forums, and her short film, Arresting Ana, presents her passionate views along with those of the bloggers and victims of the disease. Arresting Ana raises the interesting questions of whether personal health can be legislated and where, ultimately, the responsibility for this worldwide illness lies. The film includes some disturbing graphic images of emaciated women, but it generally steers clear of sensationalism and focuses on the contrasting points of view between the pro- and anti-Ana advocates. The combination of a focus on the Internet, the law, and anorexia makes this a solid choice for YA or teen collections. --Ellen Druda, Half Hollow Hills Community Lib., Dix Hills, NY
Recent research conducted by the University of Southern California regarding eating disorder stereotypes has shown that African-Americans are 50% more likely to be bulimic than white girls. The risk is also higher for those in low-income groups. Meanwhile, it is no surprise that research has found the Internet is playing an increasing role in eating disorders.
Pop culture makes it seem like it's a sickness that mainly affects wealthy white girls, notes seventeen-year-old Mattie from New York City. People picture someone like Marissa Cooper from The O.C., she says, referring to a young and glamorous TV character that struggled with the illness. There's also the pretty and privileged Blair Waldorf on Gossip Girl. And on the newsstands, photos of waiflike Hollywood starlets are splashed across tabloid covers with headlines asking if anorexia is to blame.
Since 2006, the number of pro-anorexia and pro-bulimia Web sites has ballooned by 470 percent, according to Optenet, an information technology security company. Many of these sites contain harmful content, like crash-dieting tips, photos of emaciated figures that serve as thinspiration, and advice on how to hide an eating disorder.
These findings are surprising, but the explanation for them makes sense, says Michelle Goeree, assistant professor of economics at USC and a co-author of the study. Much of the research that has been done on eating disorders only looked at young people who were already diagnosed, she points out. If a girl who is bingeing and purging is from a low-income family that doesn't have insurance, she's less likely to visit a doctor or psychiatrist who can diagnose her with bulimia. So, sadly, she and others like her have been overlooked.
Today's adolescents' interest in using pro-Ana sites is skyrocketing. Unfortunately, the Internet offers a plethora of Web sites that describe, endorse, and support eating disorders. In one study, the paper conducted by Hopkins/Stanford, researchers report on 180 Web sites that were found using search terms such as "Pro-Ana," "Pro-Anorexia," "Pro-Bulimia" and "Thin and Support." Content analyses provide systematic data on what is available and likely to be seen by users of pro-eating disorder Web sites. The features of pro-eating disorder Web sites have been examined along with the messages to which users may be exposed. It appears that a large majority (84%) of the content analyzed offered pro-anorexia content. Thus, Pro-eating disorder Web sites present graphic material to encourage, support, and motivate site users to continue their efforts with anorexia and bulimia.
