Pro-anorexia websites offering tips on extreme dieting are nothing new, but their growth on social networking sites is a disturbing new twist and brings them within reach of a wider audience.
By Jacqueline Head
As a conversation opener, it's as blatant as it is troubling.
"What diet pills work best?" a young female user of a social networking site asks. The responses begin to trickle through from other members of the group which is an online meeting place for those people with anorexia.
"They're all rubbish," says one, before another chips in with her favourite brand, which she says works well with "restricting" and "exercising". It could lose you seven pounds, she surmises.
Another user asks for good tips "for when the hunger kicks in", a request met with a slew of suggestions.
The popularity of social networking websites has opened up a whole new world of interaction, but with it, darker trends are emerging. Groups which appear to extol grave eating disorders as a glamorous lifestyle choice are appearing on sites which claim tens of millions of active users.
One of the Facebook groups
Members of such groups post pictures of painfully skinny girls for "thinspiration", compare dangerously low goal weights and measurements, and team up to "keep each other strong" in their quest to lose weight.
They swap stories on how they vomit until they cough blood, are often too weak to get out of bed and how they're scared family or friends will find out and force them into recovery.
Such groups are known as "pro-ana" and "pro-mia" - that's pro-anorexia and pro-bulimia.
Their existence on the net is nothing new. But their presence on social networking websites, which have rules against posting harmful content, raises the groups to a new respectability.
Previously, people on such internet groups remained relatively anonymous, and the groups, being small, were sometimes hard to find. But on some social networking sites, users have real names and faces, and are more accessible than before.
Such groups can be found on many social networking sites, including the biggest:
• MySpace includes groups such as Pro Ana Nation (with more than 1,000 members) which states, under its rules, "no people trying to recover, it ruins our motivation"; and Pro Extreme Dieting, which states: "we are here to support each other in our choices, even if they are to recover, or try to put on, or lose weight"
One of the MySpace groups
• Facebook includes groups such as "Get thin or die trying", "Yes, I have an eating disorder. No, it's not your problem" and "Quod me nutrit me destruit" which translates as "what nourishes me destroys me"
While the groups are dominated by American users, they include many from the UK.
Joining one "pro-ana" group can lead you to five more, and so on, opening up a world that, while posing as a means of support, more often tends to glamorise and advocate illnesses that can cause infertility, heart disease and death.
Anorexia nervosa has the highest mortality rate of any psychiatric illness. Beat, the UK's Eating Disorder Association, estimates that up to 20% of those who become seriously affected can die prematurely, and are at particularly high risk of suicide.
Andrea Schneider, a 21-year-old from Columbia, Missouri, has struggled with anorexia since she was 16. In the past 18 months she says she has been admitted to hospital 15 times and had six feeding tubes.
She used to log on to these groups to seek justification for what she was doing.
"When you are actively in your eating disorder, you desperately want someone to understand, and a lot of time you find groups like the pro groups on Facebook that are supportive of you continuing your eating disorder," she says.
"When you are in the middle of it and don't want to give it up, you cling to these sites that tell you what you are doing is OK. Recovery is hard, staying sick isn't, so it's easier to hide behind these sites claiming that you are making a lifestyle choice, rather than admitting that you are sick and trying to get better."
Many girls in these groups, aged from about 15 to 30, claim their goal weight is below seven stone (45kg), and for some it is as low as five stone (32kg).
As posted on Facebook
"We always want to be the thinnest," Andrea says. "'Thinner is the winner', that's a quote that we live by."
"You will see girls talk on these sites about hitting their goal weight, but no matter what they say, their goal weight is never going to be low enough."
Emma, a 17-year-old from New York who still uses these groups, also believes they fuel anorexia.
"Hearing girls your weight or smaller say they are fat makes you feel worthless. Ana tips can push you to take it too far and thinspirational pictures give you an unattainable goal."
Dr John Morgan, a consultant psychiatrist St George's University Hospital, London, who specialises in eating disorders, says these groups run the risk of glamorising unhealthy behaviour.
"It's become a lot more interactive, which is more worrying. It much more rapidly reinforces the negative views these people have of themselves and provides an instant response to what they're looking for."
But the impact of these groups is not entirely negative - and if properly regulated, they can be used for positive means. He says they can mirror group therapy, an important part of treatment, and help draw people out of their isolation.
"I have had some patients who have gone on pro-ana websites and then gone on to seek treatment," he says. "It's very daunting, and just having someone to hold your hand and explain the process can make a big difference."
Susan Ringwood, Beat's chief executive, says an eating disorder is a serious mental illness, not a fad, phase or lifestyle choice.
"The sooner someone gets the help they need, the more likely they are to make a full recovery - yet some aspects of the pro-ana world deliberately try to encourage people to avoid treatment.
"But it is a complex issue, because what people who use these social networks often say is that they find an acceptance and sense of belonging that they don't get anywhere else. At Beat, we want to change the way we all think and talk about eating disorders, and that means showing we can provide that acceptance and understanding, so that a pro ana group isn't the only refuge there is."
Anastasia, a 19-year-old student in London, suffers from anorexia and bulimia and uses social networking groups for support.
"People around me support me, but I can't tell them everything. In these groups I can ask questions and talk about how I feel to people I know went through the same issues and feelings."
For Emma, social networking sites are her only option for support.
"I would be found out if pro-ana sites showed up on the history of my computer. These groups really connect girls from all over and create true friendships. I myself originally set up my fake account and joined groups to get ana tips and to have a place to share my feelings and be understood, rather than judged."
A spokesman for MySpace says it can be "very tricky" to distinguish between support groups for users who are suffering from eating disorders, and groups that might be termed as pro anorexia or bulimia.
"Rather than censor these groups, we are working to create partnerships with organisations that provide resources and advice to people suffering from such problems, and we will target those groups with messages of support."
Facebook failed to respond to our questions.
Below is a selection of your comments:
I have every sympathy, concern and understanding for people suffering from eating disorders, but it can't be considered news that they use the internet, and suggesting net censorship as a solution is about as helpful as trying to making the illnesses themselves illegal. The internet *is* real life, and the problems we're talking about here need to be tackled directly, rather than by incorrectly blaming neutral technology.
I have used pro-ana sites before and have a history of eating disorders. It's a great place to go because it's often the only place you feel understood. You don't get all the patronising "you're not fat" rubbish that your friends and family tell you. As a regular user of a particular blogring for ana/mia, I can assure you that most people never really lose that much weight - it's a circle of trying to diet and failing, with very few hardcore anas on them. I can recall comments being left for one regular, checking she was OK because her weight had really dropped and a number of us were concerned for her health. People who obsess over dieting and body image will do so whether these sites exist or not, and these sites provide support and understanding from others in a similar position.
As a sufferer of bulimia I am slightly concerned that you have named the specific groups. I am in recovery so I'm not interested but there may be people looking on here who may go on to find them from the names you have provided. So-called pro-ana groups will always find places to meet on the internet, irrespective of what protective mechanisms are put in place.
Rachel Welch, Norfolk
We have to remember that the "Web 2.0" trend carries the statement of "we provide the service, you control the content"; thus social networking sites don't limit the content as much - another contributing factor to the growth of these pro-ana groups. I would assume that there are also anti-ana groups. Unfortunately we can't point the finger at the people providing the service. Content censorship is difficult on such sites for the reason that they've grown to such a size that it would take a very large team to cover all banned content and often takes a longer period of time for the situation to be seen to. This is something that end-users aren't generally aware of which can be the reason they are hasty to point the finger at the people providing the service.
Kieran, Guernsey, Channel Islands
I believe the cause of eating disorders is not due to these websites but the media glamorisation of super-thin models and actresses. These groups are the by-product. So what is the msg that is being projected to young girls with low self-esteem? If you can get this thin, you will achieve fame and fortune. Until we have healthy, curvaceous women gracing our screens and magazines, anorexia/bulimia will always be around.
Brenda Lyall, Aberdeen
Maybe the people who have recovered from this horrible illness, which they will always fight, need to set up websites and social networking as well. Everybody has the right to freedom of choice but let's balance the argument and make sure that help sites are available for those who want it. That way anyone recovering has the support they need as well.
Charmain, Falkirk, UK
Had a look on Facebook after reading this story, and a search for "pro-ana" actually reveals far more groups which are anti-pro-ana.
Anorexia is essentially a slow and painful suicide and these groups should not be allowed. As a Facebook user I had a look out of curiosity, and I could not see any of the counselling or support that it has been suggested these groups offer. All I saw were pictures of emaciated girls discussing with each other how to keep up the good work and referring to the rest of the world as interfering so and sos. This kind of information should not be so accessible on a website specifically made for young people.
Sophie U-Ming, London
I do not understand why, if these social networking websites have rules against "posting harmful content", that these groups are allowed. It is quite different from the big and proud as most of anorexics are mentally ill, very young and need professional help, not encouragement to continue self-destructing. One of my dearest friends in college suffered from this horrible disease back in the early 80s when none of us knew what it was. She confided in me and then her parents and did seek help. I am so grateful that we didn't have anyone around to tell her that what she was doing was just another "lifestyle choice".
Sheila Wilson, Highwood, IL, US
Having been a teenage girl and now as the parent of a teenage girl - bright, healthy and attractive as she is - I know that body image is of major importance to teens and that even confident girls strive to fit the perceived norm. To me the fundamental difference between usual teenage body angst and fully fledged eating disorder is an innate belief in self worth - it's not a surprise that the "recipe" above included no small measure of low self esteem.
Debbie, Halifax, UK
This is not particularly new. The internet is great in that it lets you find a small niche of people who are interested in the same things as you. This means that instead of meeting maybe one or two people who are interested in the same things, you can meet thousands. Which means that the "odd" behaviour you're interested in can quickly come to seem normal to you, after all, here are thousands of other people who are interested in the same thing. Certainly the pro-ana/mia groups are concerning, but the internet makes atypical behaviour at least appear mainstream to those involved in it.
Stephen Moore, Lisburn, UK
My partner has an eating disorder that she is slowly gaining control over. People who say this is a fad or lifestyle choice are either a) actively engaged in one of the disorders (& in denial) or b) have no knowledge of what they are commenting on. Anorexia and Bulimia are mental health issues far more serious than people believe. It's about time that our government and health organisations recognise this and began to deal with the problem, because it is a very real and dangerous issue. I for one have seen the depths of these illnesses first-hand and I can tell you it's no fad.
I'm a 14-year-old girl, and today everything seems to be based on your weight. It is natural that everyone wants to be beautiful, but it is hooked into people's minds that size zero is pretty. There's a new word "rexy" which is anorexic and sexy, when being anorexic is completely not sexy. I'm seven stone and 5'4" and I'm skinny - I'm trying to put on weight because weight is always talked about everywhere I look, from magazines to internet sites and food shops. It put me off eating for a while, I would consume at the maximum 200 calories a day.
I am a former anorexic myself, and I find this article a bit silly - it is not because you read a book about a serial killer that you will become one.
Nadège, books about serial killers don't offer you hints and tips on becoming a successful serial killer. Nor do they actively promote the serial killer "lifestyle" - pro-ana sites provide support, tips and more on how to be anorexic. I therefore find your comparison rather pointless.
Simon McMahon, Chelmsford, Essex
You really think you should have made this stuff so easy to find by mentioning the names of groups in the article? I wouldn't be in favour of censorship - but the BBC is one of the most read websites.
Having released the Pandora's Box of the internet and "social networking" sites on the world, there is little if anything that can be done realistically to restrict these.
Is this really dissimilar from the "pro-fat" groups that exist, Big and Proud and all that? Perhaps people should be left to make their own choices instead of being called mentally deranged. I'm of the opinion that if you tell someone they are suffering from a mental illness enough, they will believe it. Let these people destroy their bodies - it's called "choice".
Vaughan Jones, Nuneaton, UK
The problem is not with the social networking sites, the problem is with the people using them. There is nothing new with like-minded people getting together, be it in book clubs, the air cadets or a pro anorexia group in a social networking site. We either accept that and we let them get on with it, or we label them insane and take away their rights.
Alan Addison, Glasgow, UK
Vaughan, you elevate "choice" as the ultimate goal, and ask, why not let them destroy their bodies? Well, because they are daughters, sisters, sons, friends, loved ones. If they are in the grip of a terrible disease, they should be helped out of it, not encouraged to go further. These groups need to encourage healing, not promote dangerous practices.
Unless you have had a teenage girl with anorexia in your family, you can have no idea the suffering that it inflicts on her parents, grandparents, brothers and sisters. This is an illness where the sufferer heaps abuse on her family and any others that try to help her. Uses every trick to hide food or to get rid of what she has eaten, and may have to be strapped to a hospital bed and force feed to keep her alive. Members of my family when through five years of hell before the young woman in question recovered. Those that can write comments like the two above have no knowledge of the subject. I strongly believe an apology to all those who are or have been directly involved would be in order.
Mike Dixon, Barcelona, Spain
Vaughan, these are dissimilar because the pro-fat groups are about being comfortable and happy as you are - they are not actively prompting people to seek to attain an unhealthy weight. Most members of these sort of groups are already big, for whatever reason and have no great desire to change. The difference with anorexia and bulimia is that the person afflicted is unhappy in themselves and is seeking to make a dangerous change. Anorexia and bulimia are both recognised as psychological problems - being fat is not.
This IS quite similar to the pro-big groups - both seek to comfort members of socially unacceptable cliches (let's not forget that obesity also contributes greatly to numerous diseases and illnesses). However, while anorexia and bulimia are psychologically driven disorders, obesity is usually lifestyle-based, and therefore easier to "recover" from. In this aspect, pro-big groups are worse in perpetuating obesity in people who need mere fractions of the motivation and willpower to recover as opposed to those suffering anorexia and bulimia.
Dylan, Sydney, Australia
Who came up with the smart idea of posting that artistic photo of the skinny woman to go with the article? You're being just as bad as these pro-ana communities. As a former anorexic, I find it very triggering. So I beg you - please take down that picture.
I've been a member of Facebook now for a couple of months and had never thought of searching or looking up pro-ana sites there. I used to be addicted to pro-ana sites a year or so ago but after some help from my husband I've grown. This article is just going to highlight the fact that these pages are available and give some girls who had never thought of it a new road to follow.
Ani Nom, Wimbledon
I know a lot of people often bash anorexics and bulimics for what they do. So thanks for including the quote that reminds us that eating disorders are serious mental illnesses. I'll admit that many people with eating disorders do not recognise how serious it is, but that's part of the illness. I've used pro sites to help myself. Yes, sometimes it does more harm than good. But for the most part, the GOOD websites are really helpful and provide an atmosphere in which ana and mia girls can develop friendships with people who understand better than anyone else. Trouble starts when people "just looking to lose a few pounds" invade these groups looking for tips. Most sites post warnings saying that anorexia isn't fun, that it is a disorder and that if you don't already have an eating disorder, you should leave. It's not the creator's fault if people don't listen.
Jasmine Evans, Chester, PA, USA
These sites publish dangerous and damaging medical advice. People have no right to publish false medical advice, which is essentially what encouraging bulimia or advocating starvation is. It is not censorship to block such sites, it is healthcare.
Jonathan Dowdall, London
I have studied eating disorders as an undergraduate student, and I would just like to say that the LAST thing these young women need is to be left alone and told that this is their choice. Our societies are largely responsible for raising girls so they believe the only way they are acceptable is thin, even to the point of death. Why are we turning a blind eye to the fact that they are suffering an illness?
Laura Sayen, US
Vaughan, as the father of a beautiful, highly intelligent anorexic daughter (who was heavily encouraged by the pro sites), I can assure you that anorexia is treated as mental illness. Her choice? She would be dead now. We got help just in time.
John Cook, Dorking, Surrey
This article may be a faux pas as young women teetering between being anorexic and not will now know where to find the information that will be so harmful to them. Anorexia and bulimia are two very common and dangerous issues among women today and this article will only help those troubled few in finding out to much information they don't need. Heavy responsibility should rest on Myspace and Facebook as these networks allow this behaviour on their systems.
Stephen Kekicheff, US