Kosalina Vignarajah & Harithra Chandrasehar
This paper examines the impact of pro-eating disorder websites as determined by the researches done on the area. During the course of this paper, we have critically analyzed the findings, methodologies and conclusions given in eight research papers while providing suggestions for our opinions on them. After the analysis, we have come to a conclusion that pro-eating disorder websites are harmful to both novice viewers and regular viewers as these websites negatively affect the self-esteem, perceptions of beauty and the patterns of thinking. However, these websites are also a forum through which people with eating disorders communicate, which acts a supportive network, and is therefore positive as well.
Key words: Pro-eating disorder websites, thinspiration, Pro-ana/pro-mia.
“Nothing tastes as good as thin feels” is a quote which is often seen in pro-eating disorder websites (Bardone-Cone & Cass, 2006). Pro-eating disorder movements or websites focus mainly on influencing individuals to practice disordered behaviors of eating (by sometimes undermining the harm it can do) and increasing the eating disorder behaviors overtime without seeking treatments from professionals. These websites claim that they are ‘pro-ana’ and/or ‘pro-mia’ (for anorexia and bulimia respectively) and that they represent a lifestyle choice rather than eating disorders (Csipke and Horne, 2007).
The objective of this paper is to understand the impact of pro-eating disorder websites on people. This paper will mainly focus on why pro-eating disorder movements negatively impacts people already diagnosed with eating disorders. Additionally, this paper will have an in-depth explanation of pro-eating disorder websites, what these websites contain that benefits and negatively impacts the users, find appropriate approaches to reduce the consequences of these sites, the precautious steps that clinical professionals/therapists could take to help the victims, and the limitations and possible future studies will also be explored.
Pro-Eating Disorder websites
Pro-eating disorder websites are where individuals with anorexia or bulimia join together to feel like a community, share values and beliefs (Csipke and Horne, 2007). These movements are especially spread through websites have main three goals: the sites prevent from seeking professional help; increase the behavior of eating disorder, and using the guise of support to harm the users (Yom-Tov, Fernandez-Luque, Weber, & Crain, 2012).
Csipke and Horne (2007) have characterized websites regarding eating disorders into four main types: (1) eating disorder websites run by professionals concerned with health; (2) ‘recovery sites’ run by people with eating disorders; (3) moderate pro-ED sites that consists of beliefs and quotes regarding ‘being thin’, and (4) severe pro-ED sites that consists of ‘ANA creed or commandments’ which is similar to a movement and contains inspirational facts and information about maintaining a low body weight and looking thin.
Most of these sites contain images and messages that motivate disordered behaviors; drugs that help induce vomit; chatrooms that include individuals that support each other; a disclaimer to warn people who accidently come across the site and sometimes information about the organizer of this site is given (Overbeke, 2008). Also most of the sites have calorie charts and BMI calculator to advice the users of the exercises to undertake, to reduce weight and to help hide the disorders from others (Csipke and Horne, 2007).
Addition to sharing ‘thinspiration’ pictures of thin supermodels, the users who have eating disorders find themselves more deep into these websites because of the identity that these sites provide. And in this way, they are taught self control on food consumption and encourage to diet or fast with other fellow chatters, this is one of the main defense statement of pro-eating websites (Csipke and Horne, 2007). The contents of these sites could be harmful and is a health concern, as explained below.
Impact of Pro-Eating disorder websites
Csipke and Horne (2007) concluded that there was a positive impact (without counting the motivation to diet together) on frequent users of the pro-eating website , who were supported emotionally found themselves connecting with other users who had the same view and thought than the ‘silent’ users who were physically supported to maintain restricted eating behaviors. It is important to remember that a frequent user of the sites is not safe from disordered eating behavior, and also it is difficult for the users to come out of this behavior to recover because these sites gives them an identity.
Despite giving sense of belongingness, clear identity, and practical information in regards to anorexia, the sites have negative impacts such as lowered self esteem, and self-efficacy of being perceived as overweight which leads to eating disorders (Overbeke, 2008).
For example, Bardone-Cone and Cass (2006) stated that women who viewed pro-anorexia website showed an increase on their perceived weight and a decrease in how attractive they looked to opposite sex compared with women who viewed neutral sites, thus both the mood and the cognition of women are affected by viewing pro-eating disorder movement websites. Also users of pro-ana sites had a longer duration of illnesses and higher number of absenteeism of school due to health concerns (Overbeke, 2008).
The impact of pro-eating disorder on eating disorder is a topic that requires more attention in the future, especially the role the sites play in helping to maintain and increase eating disorder behaviors, an explanation of these popularities despite the negative impact and the reasons for why the individuals continue access these sites (Overbeke, 2008).
Approaches to Reduce the Impact of Pro-Eating Disorders Websites
A better approach can be taken to prevent these sites causing more harmful effects such as a censorship to shut down these sites from stopping the frequent users and also the users yet to connect with the site members (Csipke and Horne, 2007).
Parents should also educate themselves and their children with media literacy that gives a critical evaluation of the media and its messages and it is wiser to use ‘block’ technology at home computers if the children were alone with a technical device or else place the computers in public area of the house (Bardone-Cone and Cass, 2006). It is the duty of the parents to be aware of their children’s health to not only check for eating disorders but to also prevent from other diseases.
Yom-Tov et al. (2012) illustrated that some of the countries like Israel has taken the precaution of these harmful sites and have banned advertisements containing “severely underweight models”. On the other hand, the online servers (e.g Yahoo, MSN) have taken it upon themselves to create awareness for the harmful drugs used for eating disorder.
Overbeke (2008) suggested that by understanding the factors that influences the popularity of these sites, professionals can take relevant steps to prevent popularity of these sites. Clinical scientists should defend against statements such as these where pro-Ana movements is compared with homosexuality, that given time pro-Ana movements will be considered as a chosen lifestyle as homosexuality is considered today (Overbeke, 2008).
Treatments could include acknowledgement of these sites and how to address these issues with clients to prevent relapse and help acquire a healthy eating behaviors by letting the clients know about the influence these sites have on their health (Csipke and Horne, 2007).
In addition to above mentioned precautions that parents and therapist could take, there are some areas of studies that require the attention of researchers to study on. For example, The ambiguity of ‘pro-Ana’ makes it difficult for the researchers to study on it because different meaning is given to pro-eating disordered movements by many and most of the studies are pilot or descriptive studies that are not evidence enough to make conclusion from to check the real impacts (Overbeke, 2008).
Therefore, Yom-Tov et al. (2012) emphasized that future studies can focus on interventions where warnings about the content of the sites should be clear, understandable to any user, and importance should be given to adhere to these warnings to avoid being caught up in problems that may lead to eating disordered behavior. As mentioned above, the use of blocking from the internet servers for these sites is necessary because a caregiver cannot monitor the users all the time, and parental control software should be present for the users especially to avoid the first time users’ attention towards these sites.
“E-Ana and e-Mia: A Content Analysis of Pro–Eating Disorder Web Sites” is an article by Borzekowski et al. analyzes the content shown in a one hundred and eighty pro-eating disorder websites. According to the article, pro-eating disorder websites are often defined by their urging of viewers to use unconventional and dangerous methods to lose weight such as using laxatives. The article also mentioned that 79% of the websites were interactive thus giving viewers a forum, and that they contain “thinspiration”, tips and techniques to lose weight, and “reverse triggers” – pictures of morbidly obese people (Borzekowski et al. 2010). What was most fascinating was the details accumulated regarding the sites such as them being very easy to understand as they were compiled in eighth grade English which aids its ability to cater to its audience, and more importantly, that most of the sites had themes – including bringing control to life through eating-disorders, isolation from those who they think are fat and impure, and as artistic transformation (Borzekowski et al., 2010). A drawback of this study is the unavailability of information regarding the “underground” websites which are pro-eating disorder, as they may contain the most damaging information, as opposed to what is found in the public domain.
The article titled “Potential risks of Pro-eating disorder websites” claims that despite the negative out-cry against them, that there are currently around five hundred websites which are pro-eating disorders currently on the internet, and that around 200-400 users will be accessing those sites at any given time, while also mentioning that those who view these websites can be girls of twelve years or younger. This article also shed light to three important factors which seem to carry the most risk to those viewing a pro-eating disorder website. They are; “Operation under the guise of support”, “reinforcement of disordered eating, and “prevention of help-seeking and recovery” Interestingly it also mentions that not all pro-eating disorder websites are anti-recovery as some websites encourage the users to seek help when their eating disorder progresses (Rouleau, von Ranson 2010). This does confirm the fact that eating-disorder websites are a forum which provide support and comfort too. However, it is also possible that the triggers in the website may discourage people from seeking help, despite the disclaimer in the beginning of the page. A suggestion to counter these pro-eating disorder websites would be to have a website which appears along with the pro-eating disorder websites, which is run by completely recovered individuals who once lived with eating disorders, who can understand and even guide a person to seek help. The site can even be monitored by clinicians.
The research titled “What does viewing a pro-Anorexia website do? An experimental examination of website exposure and moderating effects” seems to be a remarkably well-thought out study. It is also a study that has been cited by many research articles discussing this topic. Technically, the article seems to be quite flawless as it covers every aspect necessary, including a pilot study, the randomization of participants, explanation of methods of testing used, and the explanation of results. the results of this study determined that viewing a pro-anorexia website made a significant impact on the participants compared to those who viewed the control websites in terms of a negative mood, low social self-esteem, low appearance self-esteem, higher likelihood to exercise and think about weight in the forthcoming days.
This study was a critical point in the research of pro-eating disorder websites as it showed the immediate after effects of viewing one. Unfortunately, it has not followed the participants out of the lab and analyzed how these websites affect their life after the initial viewing – despite the debriefing they received and the availability to psychological help. (Bardone-Cone, Cass 2007). It would be interesting to know whether any of these participants returned to viewing these websites, and to understand what drew them to it as they are considered first-time viewers, (and should technically have no reason to search for companionship in an eating-disorder website which is the reason given by many people living with eating disorders when asked why they access these sites), and whether viewing these articles and images are as damaging as they were the first time, or if the effect of it reduces each time through desensitization as the Bardone-Cone and Cass study suggests. It would also be interesting to know what changes will occur in the results if the subjects were male, or if they were from a culture that appreciates body fat, or even if it were someone who is obese and having a good self esteem. The variations of the sample are quite necessary as these sites are quite freely available on the internet, and therefore it is important to find out how different people react to these websites, as opposed to only considering the stereotypical relationship between women and anorexia. However, it would be quite dangerous to expose people to sites like these without having a good understanding of their psychological state, as eating disorders can be hidden for so long, and disguised as many other less harmful things that it may be difficult for the researchers to notice changes in a participant unless it is a long term study.
The final article “disordered eating in a digital age” is a questionnaire/survey which was linked to pro-eating disorder websites, which was answered by those accessing the site. The results were then analyzed to determine the harm caused, and although it has been impossible to determine the causality of many of these negative symptoms including low BMI, low quality of life, co-morbidity of illnesses along with psychological diagnosis, and an alarming twenty one sick days in a month of thirty days, but its strongly linked to eating disorders and these websites (Peebles et al. 2012). However, this research had a response rate of less than 40% which is not an adequate sample, while only English websites were accessed. However this study was one of the best online studies conducted in this area, was well analyzed, and the article contained the survey for references which can be helpful to the reader.
The articles above show comprehensive details about pro-eating disorder websites. Upon careful reviewing of both articles and some of these mentioned websites, it is easy to understand that there is a completely different mind-set attached to those who have purposely disordered eating habits. It seems to be like they think that they have a higher purpose, a better understanding and purer image of the human body. Their mentality seems like that of a cult, a united front with adherence to a strict regime, but it’s members breaking down within it unable to cope up with the stress and the difficulty, but struggling each day, because if they don’t, their entire belief system and the purpose they have assigned to themselves may fall apart.
Perhaps one of the most ethical ways to help these people who may not acknowledge that they require it is by doing more research about pro-eating disorder websites which helps develop their dangerous bonds and by matching each of it with a less harmful blog/website run by clinicians but is suitable and accessible to the general public. Another such proactive action would be having a minimum standard guideline that these pro-eating disorder websites need to adhere to, required by law, where the harm is detailed and the ways to get help are found, like the warning that is mandated on packs of cigarettes. It is best if these websites can be closed down by all internet servers as a matter of public safety, and encourages instead a forum or web pages which speak creatively about the struggles of beating eating disorders and victory.
In the case of research, it would be best to do more studies with diverse samples, and to do studies which assess the long term effects of these websites. It would be also interesting to have a research perspective about why these websites should exist, and it would be ideal if this research could be conducted by those who believe in the pro-eating disorder movement as it would be a good way to understand each other, with the basis of science.
Bardone-Cone, A. M., Cass, K. M. (2006) Investigating the Impact of Pro-Anorexia Websites: A Pilot Study. European Eating Disorders Review 14, 256-262.
Bardone-Cone A M. and Cass K M. (2007) What Does Viewing a Pro-Anorexia Website Do? An Experimental Examination of Website Exposure and Moderating Effects, International Journal of Eating Disorders 40:6 537–548 DOI 10.1002/eat
Borzekowski D LG, Schenk S, Wilson J L, Peebles R (2010) e-Ana and e-Mia: A Content Analysis of Pro–Eating Disorder Web Sites. American Journal of Public Health, Volume 100, No 8.
Csipke, E., Horne, O. (2007) Pro-Eating Disorder websites: user’s opinions. European Eating Disorders Review,Volume 15, Issue 3, pages 196-206.
Overbeke, G. (2008) Pro-Anorexia Websites: Content, Impact, and Explanations of Popularity. Mind Matters: The Wesleyan Jounral of Psychology, 49-62, Vol. 3.
Peebles R, Wilson J,Litt I F,Hardy K K;Lock D (2012) Disordered Eating in a Digital Age:Eating Behaviors, Health, and Quality of Life in Users of Websites With Pro-Eating Disorder Content. Journal of Medical Internet Research 14.5
Rouleau C R, von Ranson K M (2010) Potential risks of pro-eating disorder websites, Clinical psychology review 31- Elsevier. doi:10.1016/j.cpr.2010.12.005
Yom-Tov, E., Fernandez-Luque, L., Weber, I., Crain, S. P. (2012) Pro-Anorexia and Pro-Recovery Photo Sharing: A tale of Two Warring Tribes. Journal of Medical Internet Research.