Story by Jim Schnabel
In the alternate reality of anorexia and bulimia, no thin is too thin, and control and perfection are codes for continued starvation. Facing social disapproval, some “anas” and “mias” form their own supportive communities—which the Web now makes easier than ever.
“For almost any high-risk behavior nowadays there’s a website community,” says Dina Borzekowski, EdD, EdM, MA, an associate professor in Health, Behavior and Society. “There are websites for people who are into cutting behaviors or suicidal ideation. So it’s not surprising that there are websites for pro-ana and pro-mia behaviors.” Anorexics eat rarely or not at all; bulimics binge but then purge by vomiting or using laxatives or enemas.
In the June 17 issue of the American Journal of Public Health, Borzekowski and colleagues at the Bloomberg School and Stanford University report the most comprehensive content analysis to date of pro-ana/mia websites. Nearly all (91 percent) of the 180 sites they found were easily accessible to casual browsers, and most (84 percent) presented pro-ana content, while about two-thirds presented pro-mia content.
Such content typically included “thinspiration” images of skinny models or celebrities (85 percent), and helpful guides for ana/mia behaviors (83 percent), including purging tips and the concealment of weight loss from loved ones.
Yet as Borzekowski and her colleagues found, there are also many ambiguous and contradictory messages on these sites. More than a third (38 percent) contained recovery-related information, for example. In part this may reflect a desire to evade legal liability or adverse action by website hosting companies, says Borzekowski. Earlier in the decade, under pressure from health professionals, Yahoo and MSN shut down many pro-ana/mia sites, some of which later reappeared with new names and less one-sided content.
The thematic ambiguity on some of these sites may also simply reflect their role as virtual communities of tolerance. “People who suffer from these disorders face a lot of isolation,” Borzekowski says.
Sarah Brotsky, PsyD, a psychologist in private practice in Bloomfield Hills, Michigan, spent two months participating in these online communities for a research project published in 2007. “In conversations I had with different members, they seemed to need frequent reassurance and validation, and it appeared that their offline relationships often weren’t very strong,” she says.
That sense of social validation can derive from the content too, Brotsky adds. Nowadays her patients who struggle with eating disorders often come to her having obviously picked up online pro-ana/mia material, such as the Thin Commandments (“Thou shall not eat without feeling guilty”…). Says Brotsky: “It tends to make therapy more difficult by keeping the person more enmeshed in the eating disorder.”
Borzekowski and her colleagues have been conducting a formal, soon-to-be-published study of these websites’ effects on eating-disorders patients who are in treatment. But even in this initial, just-published study, they made preliminary ratings of ana/mia website themes. “About a quarter of them conveyed what we regarded as very harmful messages,” Borzekowski says.
Borzekowski notes that the Web has now evolved so that proportionately fewer sites are under the authority of large, publicly minded service providers such as Yahoo, so a widespread shutdown even of the most militant pro-ana/mia sites is unlikely to happen. “But we as public health researchers can clarify the threat they pose,” she says. Reliable evidence can be useful for those who want to reach out more effectively to people who are suffering from these disorders, she says.
That threat is clearly a dynamic one. Even in the short time since Borzekowski and her colleagues finished gathering data for this study, more and more havens for ana/mia communities have sprung up online, for example on Facebook, MySpace and other social networking sites. “These days you can even get ‘thinspiration’ through Twitter, and tweets with extreme dieting tips,” Borzekowski says.
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