Pro-ana


Promotion of anorexia is the promotion of behaviors related to the eating disorder anorexia nervosa. It is often referred to simply as pro-ana or ana. The lesser-used term pro-mia refers likewise to bulimia nervosa and is sometimes used interchangeably with pro-ana. Pro-ana groups differ widely in their stances. Most claim that they exist mainly as a non-judgmental environment for anorexics; a place to turn to, to discuss their illness, and to support those who choose to enter recovery. Others deny anorexia nervosa is a mental illness and claim instead that it is a lifestyle choice that should be respected by doctors and family.
Pro-ana sites often feature thinspiration : images or video montages of slim women, often celebrities, who may range anywhere from being naturally slim to emaciated with visibly protruding bones. The scientific community recognises anorexia nervosa as a serious illness. Some research suggests anorexia nervosa has the highest rate of mortality of any psychological disorder.

Culture

Medical professionals treating eating disorders have long noted that patients in recovery programs often "symptom pool", banding closely together for emotional support and validation. In this context, people with anorexia may collectively normalize their condition, defending it not as an illness but as an accomplishment of self-control and an essential part of their identity, with some members of these online communities going as far as claiming that starving oneself is a lifestyle choice rather than an illness. These 'lifestyle' claims may be a symptom of anosognosia. Other community members band together for support in managing their illnesses, such as sharing harm reduction tips and having others to talk to about their experiences that are going through the same thing. Many individuals in pro-ana communities use the phrase "pro for myself, not anyone else" to indicate that they are only interested in furthering their own disorders, not encouraging anyone else to imitate their behavior.

Online presence

Such advocacy has flourished on the Internet, mainly through tight-knit support groups centred on web forums and social network services such as Tumblr, Xanga, LiveJournal, Facebook and Myspace. These groups are typically small, vulnerable, partly hidden and characterized by frequent migrations. They also have a high female readership and are frequently the only means of support available to socially isolated anorexics.
Members of such support groups may:
  • Endorse anorexia and/or bulimia as desirable.
  • Share crash dieting techniques and recipes.
  • Coach each other on using socially acceptable pretexts for refusing food, such as veganism.
  • Compete with each other at losing weight, or fast together in displays of solidarity.
  • Commiserate with one another after breaking fast or binging.
  • Advise on how to best induce vomiting, and on using laxatives and emetics.
  • Give tips on hiding weight loss from parents and doctors.
  • Share information on reducing the side-effects of anorexia.
  • Post their weight, body measurements, details of their dietary regimen or pictures of themselves to solicit acceptance and affirmation.
  • Suggest ways to ignore or suppress hunger pangs.
Many have popular blogs and forums on which members seek companionship by posting about their daily lives or boasting about personal accomplishments of weight loss. The communities centred on such sites can be warmly welcoming or sometimes cliquish and openly suspicious of newcomers. In particular, hostility is often leveled at:
  • The non-eating disordered who express disapproval, including the spouses, relatives and friends of members who appear on-site to post threats and warnings.
  • Casual dieters who join, believing that inducing eating disorders will cause them to lose weight more effectively. Such people are often derisively referred to as "wannabes" or "wannarexics".

    Thinspiration

Pro-ana sites often feature thinspiration : images or video montages of slim women, often celebrities, who may range anywhere from being naturally slim to emaciated with visibly protruding bones. Pro-ana bloggers, forum members and social networking groups likewise post thinspiration to motivate one another toward further weight loss. Conversely, reverse thinspiration features images of fatty food or overweight people intended to induce disgust. There exists significant controversy between supporters and opponents of thinspiration; some assert that thinspiration only "glorifies" eating disorders while some thinspiration bloggers argue that the purpose of thinspiration is to support a healthy level of weight loss.
Thinspirational clips circulate widely on video sharing sites, pro-ana blogs often post thinspirational entries, and many pro-ana forums have threads dedicated to sharing thinspiration. Thinspiration can also take the form of inspirational mantras, quotes or selections of lyrics from poetry or popular music.
Thinspiration often has a spiritual-ascetic flavour, referring to fasting through metaphors of bodily purity, food through allusions to sin and corruption, and thinness through imagery of angels and angelic flight. Exhortations like "Ana's Creed" and "The Thin Commandments" are also common.

Appeal

Social researchers studying pro-ana have varied explanations for its popularity, with some characterizing it as a rejection of modern consumerism and others suggesting that pro-ana functions as a coping mechanism for those already emotionally stressed by eating disorders. However, most agree on two elements of pro-ana sites:
  • Initially, pro-ana sites attract both the non-eating disordered and the eating-disordered.
  • Pro-ana sites give their members a strong sense of community and common identity.

    Fashion

Red bracelets are popularly worn in pro-ana, both as a discreet way for anorexics to socially identify and as a tangible reminder to avoid eating. Pro-mia bracelets, likewise, are blue or purple. Most such bracelets are simple beaded items traded briskly on online auction sites.

Impact

Proliferation

Pro-ana has proliferated rapidly on the Internet, with some observers noting a first wave of pro-ana sites on free web hosting services in the late 1990s, and a second wave attributed to the recent rise of blogging and social networking services.
A survey by Internet security firm Optenet found a 470% increase in pro-ana and pro-mia sites from 2006 to 2007. A similar increase was also noted in a 2006 Maastricht University study investigating alternatives to censorship of pro-ana material. In the study, the Dutch blog host punt.nl began in October 2006 presenting visitors to pro-ana blogs on its service with a click-through warning containing a disparaging message and links to pro-recovery sites. Although the warnings were a deterrence, the number of such blogs actually increased tenfold, with their monthly traffic figures doubling on average by the end of the study.

Viewership

In a 2009 survey by the Katholieke Universiteit Leuven of 711 Flemish high school students aged 13–17, 12.6% of girls and 5.9% of boys reported having visited pro-ana websites at least once. In another 2009 survey, by parental control software vendor CyberSentinel of 1500 female Internet users aged 6–15, one in three reported having searched online for dieting tips, while one in five reported having corresponded with others on social networking sites or in chat rooms for tips on dieting.
Visitors to pro-ana web sites also include a significant number of those already diagnosed with eating disorders: a 2006 survey of eating disorder patients at Stanford Medical School found that 35.5% had visited pro-ana web sites; of those, 96.0% learned new weight loss or purging methods from such sites.

Effect

Pro-ana sites can negatively impact the eating behavior of people with and without eating disorders. One study of individuals without eating disorders demonstrated that 84% of participants decreased caloric intake by an average of 2,470 calories per week after viewing pro-ED websites. Only 56% of participants actually perceived the reduction in their intake. Three weeks after the experiment, 24% of participants reported continuing weight control strategies from pro-ana websites, though they did not continue to visit those sites. Controls viewing health and travel websites did not decrease caloric intake at a significant level. Other studies have found that women with varying levels of eating disorder symptomatology were more likely to engage in image comparison and exercise after viewing pro-ana websites versus control websites.
Pro-ana sites can negatively impact cognition and affect. Women who viewed a pro-ana site, but not control sites focused on fashion or home décor, experienced an increase in negative affect and decreases in self-esteem, appearance self-efficacy, and perceived attractiveness. They also reported feeling heavier and being more likely to think about their weight. The effects of perfectionism, BMI, internalization of the thin ideal, and pre-existing ED symptomatology as moderators of negative affect were comparable to chance, suggesting that pro-ana websites can affect a broad spectrum of individuals, not simply those with ED characteristics.
A 2007 survey by the University of South Florida of 1575 girls and young women found that those who had a history of viewing pro-ana websites did not differ from those who viewed only pro-recovery websites on any of the survey's measures, including body mass index, negative body image, appearance dissatisfaction, level of disturbance, and dietary restriction. Those who had viewed pro-ana websites were, however, moderately more likely to have a negative body image than those who did not.
Similarly, girls in the 2009 Leuven survey who viewed pro-ana websites were more likely to have a negative body image and be dissatisfied with their body shape.
A 2012 report by Deloitte Access Economics, commissioned by Australian non-profit The Butterfly Foundation, estimated that eating disorders resulted in productivity losses totaling just over $AUD15 billion, with 1828 dying that year from eating disorder-related complications.