By Elizabeth Zwerling
Tuesday, September 16, 2003
Young women looking on the Internet for help with their eating disorders are instead finding a proliferation of sites that encourage their unhealthy habits. Some researchers, however, say the sites offer a therapeutic "window" on a baffling disease.
(WOMENSENEWS)--Thousands of isolated young women today are turning to the Web for help as they struggle with eating disorders, but the kind of support they are finding when they type "anorexia" or "eating disorder" into a search engine may be more harmful than helpful.
Unrealistically thin role models for young women, combined with young women's increasingcomfort with the Internet as a source of community, have given rise to so-called pro-Ana (anorexia), pro-Mia (bulimia) and pro-ED (eatingdisorders) Web sites.
The sites started cropping up about four years ago. Today they number around 400.
"The most upsetting thing is that people looking for help on the Internet go onto these sites without meaning to and they are pulled in," said Carolyn Costin, executive director of the Los Angeles-based Eating Disorder Center of California and author of "Your Dieting Daughter . . . Is She Starving For Attention?" Once on the site, the visitors are told "keep your willpower," Costin said. "They are given tips for keeping the eating disorder going."
These messages are particularly damaging when dealing with a disease, such as anorexia, characterized by the reluctance to recover, Costin said.
The National Association of Anorexia Nervosa and Associated Disorders and other advocates have been working for years to shut down these sites, which they believe may cause sufferers to postpone treatment and even trigger the disorders in vulnerable young people.
However, some researchers believe the sites, while disturbing, deserve attention as they could offer some insight into baffling diseases with poor recovery rates.
"This whole idea that these communities exist could lead to a really productive discussion," said Maria Mastronardi, a University of Illinois communications researcher, who recently presented a paper on the "moral panic" over pro-Ana sites.
Part of what makes these disorders difficult to understand and treat is the secrecy of sufferers, who hide their illness from friends, family and therapists. Mastronardi believes the candid discourse found at these pro-Ana sites could provide needed insight into the thoughts and feelings of the anorexic or bulimic mind.
With names like "Anorexic Nation," "Invisible Existence," and "I Love You to the Bones," these often elegantly designed Web sites feature dangerous dieting tips, such as consuming only celery, diet soda and cigarettes; "thinspirational" slogans, such as "Anorexia is a Lifestyle Choice, Not a Disease;" photo galleries of emaciated women; and chat rooms where visitors share personal stories intended to help one another embrace eating disorders and reach dangerously low weight goals.
Suggestions found at the site "Good Anas Never Die" included: "Swallow two tablespoons of vinegar before eating to suck the fat out of your food; use Crest White Strips (you can't eat when they're on); make your mind think that the pain from being hungry is just really that you're full; (and) water, water, water! . . . Remember no one can know about Ana, so if you stay hydrated, you are less likely to pass out."
"Metabolism shutting down, need advice!" began a recent entry on the "Pro-Ana Suicide Society" Web site's chat room. "Okay, I've been doing the fast/restrict thing very meticulously for a little over a month now, and I'm nine pounds above my lowest weight ever. That was still way too high, but c'est la vie . . . However, I've been on about 150-300 calories a day and stayed the same for about one week now. Metabolism's absolutely gone. I guess it's time to refeed? How many calories do you recommend, and for how long should I do it before starting my 'diet' again?"
"Fibers, fibers are the key," the reply read. "I mean, eat a piece of wood . . . Nah, green vegetables are good, cucumbers, bread with a lot of fiber. It's not the amount of calories, it's the amount of fiber . . ."
A recent "Anorexic Files" entry read: "I think you're all fat. Maybe if you went three-to-four days without food, and did two-to-six hours of hard exercise, some of you fat asses would lose a couple pounds of needless weight. I'm 6'1" and down to 89 pounds . . . If I can do it, you people can do it too. JUST TRY HARDER. Don't believe people when they say it's unhealthy, it's perfectly natural to purge food."
"I actually liked when you called me fat," read one of a dozen replies to this entry. "I mean s*it, you just gave me some motivation . . . I feel like I need to do more to get skinny . . . Keep up the negativity, it actually helps. Call yourself fat, look in the mirror, poke it, grab it. STOP talking about it and DO it."
"Sweetie," another chatter replied, "I know you like to be called fat for motivational purposes . . . Instead, I offer this POSITIVE motivation: You are not fat. The fact that you are already skinny and can afford to eat and STILL won't shows strength in you that many lack. KEEP IT UP because it's that willpower in addition to a skinny body that's beautiful . . ."
Occasional damning messages from friends and family of the afflicted can also be found in these chat rooms, along with messages from therapists offering counsel.
Anorexia nervosa is a psychological disorder characterized by a distorted body image and the compulsion to gain control by losing weight. Consuming only a few hundred calories a day and exercising compulsively, anorexics are often dangerously underweight yet still see themselves as fat. Bulimia, which is closely related to anorexia, is characterized by binging and purging to lose or maintain a low-to-normal body weight.
Roughly 7 million girls and women and 1 million boys and men suffer from eating disorders, according a recent report by the National Association of Anorexia Nervosa and Associated Disorders, based in Los Angeles. Eighty-six percent of those afflicted report onset by age 20. The diseases have a 50 percent cure rate, and 6 percent of sufferers will die from the disorders.
"More people die from anorexia than any other psychiatric illness," Costin said.
The disorders have a variety of triggers, said Steven Levenkron, a New York-based psychotherapist and author of several books on the subject including "The Best Little Girl in the World." Among them are childhood traumas, such as sexual abuse and growing up with alcoholic parents.
"Being isolated is a key feature of the disorders," Costin said. "You're so malnourished, you avoid friends and going out. That just fosters someone going on the Internet and building a fake community."
Costin said she found out about the pro-Ana sites from clients who told her they got encouragement from the sites to "stay with us, don't go into treatment."
In psychology circles, these disorders are known as egosyntonic, meaning that the sufferers like their illnesses, Costin said. Because anorexics and bulimics are "ambivalent at best" about recovery, stumbling on one of these sites--which is what many do when they are reaching out for help--often will delay their treatment.
"Support like this makes it harder for them to break through the denial about the illness," Costin said
Levenkron, who has counseled anorexics for 30 years, said the worst thing about these sites is that they seem to fill the need for a supportive friend, parent or therapist. "We don't want them bonding with a sick, confused voice."
Mastronardi argues, however, that there is much more to these sites than such bonding. The pro-Ana sites provide a forum for these young women to share their voices, however sick, without judgment. And their discourse could provide a window into the many ways young women process messages about their bodies, food and femininity.
She believes pro-Ana sites came about as a response to a contradictory, media-saturated society, where women are taught from a young age to try to change their bodies.
Shannon Bonnette, 25, who struggled for 16 years with anorexia and bulimia, said the pro-Ana Web sites contributed to her recovery.
"The benefit is certainly the degree of honesty with which people can communicate in such an uninhibited environment," said Bonnette, a volunteer fire fighter in Ohio. "However the detriment is that some of these on-line communities do more than just offer a place to be oneself. They actually promote this behavior, this illness."
Bonnette said visiting the sites showed her the "repetitive and horrible reality" of her illness. "Some people never came back and we heard they had died. Others would get to their goal weight and be more miserable than they were to begin with. I realized it was a never-ending cycle and if I didn't escape it I'd be trapped for life and probably die. I think people need that reality check."
Elizabeth Zwerling is an assistant professor of journalism at the University of La Verne in Southern California.
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