Pro-Anorexia Web Sites: The Thin Web Line

Are these web sites fueling an epidemic?

WebMD Feature Reviewed by Charlotte E. Grayson Mathis, MD

"Thinspiration." "Ana." "Mia." "I love you to the bones." This is the vocabulary of a burgeoning subculture of web sites known as "pro-ana," meaning proanorexia. Created primarily by young women who have anorexia or bulimia, or are in recovery from one or both of the disorders, these sites have been making headlines and horrifying parents and doctors for several years. The sites speak of anorexia and bulimia as if they were almost human, hence the names Ana and Mia. The illnesses are treated almost like beloved but demanding and relentless old friends. They feature photos of rail-thin actresses and models as "thinspiration," and offer tips on suppressing hunger pangs and hiding the evidence of missed periods or vomiting spells. But what's most important, say the sites' creators and visitors, is the support they find from people who understand what they're going through. "It's a place where we can find like-minded people," says 19-year-old Lizzy, a young woman from the San Francisco area who's created one of the better-known "pro-ana" sites. "Most people don't understand what it's like: They see anorexia as a disease to be cured, but they don't realize that it's also a mental demon that you have to deal with every day. At sites like mine, people can talk about what they're feeling without being judged." There's no doubt that sites like Lizzy's are shocking and troubling. "Imagine if there were web sites encouraging people not to get treatment for cancer, or celebrating how great it is to have diabetes," observes Doug Bunnell, PhD. "They promote a myth that eating disorders are choices, rather than a physical and mental illness." But are they doing real harm, or are they just provoking a lot of controversy? Bunnell thinks they're doing serious harm. "In my group of patients, these things are really damaging. Patients are supported in their illnesses and encouraged to stay ill by these web sites," he says. "Anorexia and other eating disorders are notoriously difficult to treat, and one primary reason is because the patient's wish to get better is an ambivalent wish. Things drawing someone toward that illness can be quite damaging." First Study of Anorexia Sites Until recently, no studies have looked at the real-life usage of pro-ana sites by people with eating disorders, or at the health effects that might go hand in hand with visiting such sites. In May 2005, Stanford researchers presented the results of what they say is the first study designed to assess the health impact of visiting these sites, which outnumber "pro-recovery" web sites by a factor of five to one. The results weren't as clear-cut as you might expect, explains Rebecka Peebles, MD, a specialist in adolescent medicine at the Lucile Packard Children's Hospital. She co-authored the study with medical student Jenny Wilson. It's clear that adolescents with eating disorders are using the sites -40% of those responding to the survey had visited pro-anorexia sites. But nearly as many -- 34% -had visited pro-recovery sites, and about a quarter visited neither