Background and History
Documented accounts of “disordered eating” patterns date back as far as the Middle Ages, when religious and spiritual groups began practicing fasting as a part of their ceremonies and rituals (Bynum 1985). However, around the time of the European colonization of the Americas, voluntary starvation began to evolve from purely a religious ritual to a means of satisfying the social construct of an ideal physique (Vandereycken and van Deth 1994).
Psychologists and Sociologists alike have long noticed that those who exhibit “atypical eating patterns” such as voluntary starvation commonly band together in secret to support and encourage each other’s anorexic tendencies. Although medical professionals construct this subcultural deviance as a psychological and medical disease, pro-ana members argue that this deviant label/diagnosis is simply a response to their eating patterns being an exception from the norm. By normalizing anorexia, pro-anas deconstruct the deviant label placed on their eating patterns by classifying it as a lifestyle choice rather than an illness. With the rise in internet accessibility, the pro-ana movement began to shift to an online community of websites in the 1990s, increasing further yet in the late 2000s with the growing popularity of online blogs.
The term “pro-ana” refers to a movement promoting behaviors associated with anorexia nervosa and challenges established biomedical and psychological labeling of anorexia as a health disorder by advocating for anorexia as a sustainable lifestyle preference. Pro-ana online communities exist in many forms, the most prevalent of which are blogs, groups on social networking sites, bulletin boards, static websites, or email groups (Boero and Pascoe 2012). Some of the most popular pro-ana sites include “The Pro-Ana Lifestyle Forever,” “Pro Ana Tips and Tricks,” and “My Pro-Ana,” with the overwhelming majority of subcultural participants being white adolescent females. For these individuals, pro-ana sites provide support and advice for those seeking to initiate or maintain their anorexia. Internet anonymity allows pro-anas to seek encouragement and validation for their anorexia while not disturbing their friends and family with their “disease.” Pro-ana online communities provide an avenue for struggling anorexics to connect with each other, offer and receive emotional support, develop a common language and specialized vocabulary, and uphold the deviant pro-ana lifestyle (Tong 2013; Boero and Pascoe 2012). For some, pro-ana communities may serve as a coping mechanism for living with the emotional and physical pain of eating disorders (Mulveen and Hepworth 2006). Often, pro-anas feel isolated from their family and friends, who view pro-ana disordered eating as “irrational and self-inflicted” (Rich 2006). Thus, these sites can offer pro-anas the rare chance to seek sympathy from their like-minded peers.
While the deviance or harmful affliction of anorexia may seem self-evident, it is important to consider that the mainstream definition of anorexia is constructed by physicians who personally and professionally benefit from anorexics seeking “recovery.” Additionally, people often take for granted the word of field professionals as an intrinsic truth, considering themselves insufficiently informed to be able to place a judgment on such issues. Thus, given the deviant label placed on anorexia by medical professionals, it is not surprising that public criticism and concern for users participating in pro-ana websites is extremely wide spread. While many users report that pro-ana sites are an important part of their recovery process, these very users tend to exhibit intensified symptoms of eating disorders following the visiting of pro-ana sites (Rouleau and Ranson 2011). Further, the viewing of pro-ED websites has been shown to correlate with negative psychological effects on young women, including decreased self-esteem and self-efficacy, decreased perceived attractiveness, and increased perceptions of being overweight (Bardone-Cone and Cass 2006).
Widespread concern surrounding pro-ana websites first emerged 2001 after Oprah Winfrey aired a special on anorexia and the dangers of the online pro-ana community, with concern quickly growing into a moral panic. Soon after, the public began to call for websites to ban/censor any such content, leading many web portals such as Yahoo and AOL to shut down any and all forums containing potentially pro-eating disorder content (Holahan 2001). As a result, pro-ana members were forced to be more covert and move their forums further underground. Many sites now screen for members to avoid adding anyone to the community who may report its activity to the web portal. Further, pro-ana websites often disguise themselves under the pretense of support for those seeking treatment, and 11% of website posts contain advice for lying and concealing symptoms from family members (Harshbarger, Ahlers-Schmidt, Mayans and Hawkins 2009). Thus, due to a combination of sites being hidden by privacy settings and having intentionally misleading names, it is impossible to identify the number of pro-ana sites online at any given time, although evidence suggests that prevalence could be anywhere from the hundreds to the thousands (Boero and Pascoe 2012).
Although pro-ana sites may differ somewhat in their content, several themes seem to be present in the majority of forums. Social support plays a very important role in pro-ana blogs, with most communities offering in-depth emotional support, esteem support, informational sharing, and reciprocal self-disclosure (Tong 2013). Common website themes include tips and techniques, social support, ana vs. anorexia nervosa, and anorexia justification (Mulveen and Hepworth 2006). Most tips and tricks were found to be directed at dieting/restricting caloric intake (28.6%) and distraction from hunger (14%) (Harshbarger et al. 2009). Additionally, 84% of pro-ana sites feature “thinspiration” content, which includes images of very thin women to inspire pro-anas towards their weight loss goal (Borzekowski, Schenk, Wilson and Peebles 2010). Users often suggest that pro-anas take a picture of themselves in very revealing clothing to look at for fasting motivation whenever they are hungry.
Though there are no openly pro-ana celebrities, forum members collectively look up to thin, white female models such as Kate Moss, often citing her now infamous line that “nothing tastes as good as skinny feels.” Although the pro-ana movement remains almost entirely underground, subcultural participation continues to grow, with the viewership of pro-ana sites having increasing over tenfold in the last ten years (Boero and Pascoe 2012). What follows is a brief tour through the history of the pro-ana subculture using key themes and media contributions to illustrate significant moments in the scene.
Almost all pro-ana sites uphold that anorexia is something to be actively participated in rather than a disease to be diagnosed. Consequently, some members reinforce that these forums are not welcome to those seeking recovery, going so far as to exclude members who do not meet their criteria of identifying and participating in anorexic/bulimic practices (Brotsky and Giles 2007). Most commonly, pro-ana bloggers seek to ward off “wannarexics,” or people who wished they were anorexic to lose weight or be trendy, but are not (Boero and Pascoe 2012). Boero and Pascoe (2012) assert that pro-anas look down on wannarexics as people “who occasionally diet but are not dedicated to an eating disordered lifestyle.” By distinguishing themselves from wannarexics, pro-ana bloggers reinforce their participation in and identity for the pro-ana subculture. In this way, subcultural authenticity plays an integral part in the content of pro-ED websites as well as who contributes to and participates in them.
Additionally, the authenticity of online members can be a practical necessity for the online sustainability of the subculture. Due to the sensitive nature of the information shared on pro-ana sites, many web portals will shut down online forums once they are made aware of their existence, citing potentially harmful or inappropriate content. Thus, screening members for the “realness” of their eating disorder serves as a way for pro-anas to prevent their site from being reported and ensure its prolonged existence.
It has long been the case that eating disorders are significantly more prevalent among females than males (Striegel-Moore et al. 2009; Lewinsohn et al. 2002). In fact, the disproportionate gender participation in disordered eating dates back to the early 1800s, with popular books from the time “warning elite women of the dangers of indulgent and over-stimulating eating, and advised how to consume in a feminine way” (Bordo 2004).
Nowadays, eating disorders continue to be a gendered phenomenon, with 90–95% of anorexics and bulimics identifying as female (Koski 2008). In fact, women are ten times more likely to exhibit ED symptoms than men (Gordon 2000; Hesse-Biber et al. 2006). When reflecting on their body image, males typically regard themselves as being too thin, contradictory to females who tend to classify themselves as overweight (Levinson, Powell and Steelman 1986). Further, women who identify as more feminine are more likely to exhibit anorexic tendencies (Pritchard 2008). On the other end, while males are encouraged to promote their masculinity by growing lean and muscular bodies, this body ideal rarely leads to disordered eating (Bell and McNaughton 2007; Dworkin and Wachs 2009).
However, a crucial limitation of examining the relationship between gender and online pro-ana activity is that there is no standardized way to identify the gender of users participating in online forums. Although some researchers attempt to combat this by doing their best to identify user gender based on members’ information (username, picture, biographical information, information in blog posts), some males may pose as females to interact with other eating disordered individuals and avoid the stigma of “manorexia” (Woolridge, Mok and Chu 2014).
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Dying to Be Anorexic (BBC, 2007)
A BBC documentary investigating the underground world of pro-ana websites by following the online and offline lives of three young pro-anas.
The Truth About Online Anorexia With Fearne Cotton (2009)
An investigative documentary examining the experiences of eating disordered girls on pro-ana websites to determine the common external motivations behind site visitation and participation.
Thin (HBO, 2006)
An HBO feature documentary revolving around the recovery struggles of four anorexic women being treated for their eating disorders at The Renfrew Center in Coconut Creek, Florida.
“Girls Who Don’t Eat” (2001)
A 2001 Oprah special on anorexia expressing panic at the emergence of pro-ana websites, in which she recommended that such sites be censored and/or banned via regulation.
“Growing Up Online” (PBS, 2008)
A PBS television program focusing on the potential dangers that online networking poses to growing teens, included in which was a discussion of the online pro-ana community.
Hunger Point (2003)
A movie following the struggles of two sisters who both wish they were thinner. However, because one of them is a diagnosed anorexic and the other is not, they experience their respective desired weight loss very differently.
Dying to Dance (2001)
This movie specifically focuses on the intense pressure that the ballet community puts on their dancers to be extremely thin. A comforting watch for any dancer who thinks that they alone struggle with body-image issues in their community.
Sharing the Secret (2000)
This popular made-for-tv movie provides an interesting look into how teenagers with disordered-eating patterns can form intense bonds with their peers over shared anorexic tendencies.
Bordo offers an interesting sociological look arguing against eating disorders as a medical disease. Bordo argues that anorexia and bulimia are actually logical (and effective) approaches to achieve the ideal physique represented in mainstream media and society.
Dworkin and Wachs provide an in-depth examination into how body-image ideals and fitness expectations differ according to gender.
Similar to Bordo, Gordon looks towards history and psychology to offer sociological explanations for disordered eating. A necessary read for beginning to think of anorexia, and pro-ana, as a subculture rather than a medical or psychological disease or disorder.
An analysis into the motivations behind self-induced starvation throughout history. In offering religious, social, and literary interpretations of anorexia, Vandereycken and Deth implicitly suggest that anorexia (and pro-ana) can be understood as a sociological phenomenon rather than a medical diagnosis.
Boero, Natalie and C.J. Pascoe. 2012. “Pro-anorexia Communities and Online Interaction: Bringing the Pro-ana Body Online.” Body & Society 18(2):27-57.
Brotsky, Sarah and David Giles. 2007. “Inside the ‘Pro-ana’ Community: A Covert Online Participant Observation.” Eating Disorders: The Journal of Treatment and Prevention 19:93-109.
Mulveen, Ruaidhri and Julie Hepworth. 2006. “An Interpretative Phenomenological Analysis of Participation in a Pro-anorexia Internet Site and Its Relationship with Disordered Eating.” Journal of Health Psychology 11(2):283-296.
Pritchard, Mary. 2008. “Disordered Eating in Undergraduates: Does Gender Role Orientation Influence Men and Women the Same Way?” Sex Roles 59(3):282–9.
Rich, E. 2006. “Anorexic Dis(connection): Managing Anorexia as an Illness and an Identity.” Sociology of Health & Illness 28:284–305.
Striegel-Moore, Ruth, Francine Rosselli, Nancy Perrin, Lynn DeBar, Terence Wilson, Alexis May, and Helena Kraemer. 2009. “Gender Difference In The Prevalence Of Eating Disorder Symptoms.” International Journal Of Eating Disorders 42(5):471-474.
Tong, Stephanie. 2013. “The Use of Pro-Ana Blogs for Online Social Support.” Eating Disorders: The Journal of Treatment and Prevention 21:408-422.
Wooldridge, Tom, Caroline Mok and Sabrina Chiu. 2014. “Content Analysis Of Male Participation In Pro-Eating Disorder Web Sites.” Eating Disorders 22(2):97-110.
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Bardone-Cone, Anna and Kamila Cass. 2006. “Investigating the Impact of Pro-anorexia Websites: a Pilot Study.” European Eating Disorders Review 14(4):256-262.
Bell, Kristin and Darlene McNaughton. 2007. “Feminism and the Invisible Fat Man.” Body & Society 13(1):107–31.
Borzekowski, Dina, Summer Schenk, Jenny Wilson and Rebecka Peebles. 2010. “e-Ana and e-Mia: A Content Analysis of Pro–Eating Disorder Web Sites.” American Journal of Public Health 100(8):1526-1534.
Bynum, Caroline. 1985. “Fast, Feast, and Flesh: The Religious Significance of Food to Medieval Women.” Representations 11:1-25.
Harshbarger, Jenni, Carolyn Ahlers-Schmidt, Laura Mayans, David Mayans and Joseph Hawkins. 2009. “Pro-anorexia Websites: What a Clinician Should Know.” International Journal Of Eating Disorders 42(4):367-370.
Hesse-Biber, Sharlene, Patricia Leavy, Courtney Quinn and Julia Zoino. 2006. “The Mass Marketing of Disordered Eating and Eating Disorders.” Women’s Studies International Forum 29(2):208–24.
Koski, Jessica. 2014. ‘“I’m Just a Walking Eating Disorder’: The Mobilization and Construction of a Collective Illness Identity in Eating Disorder Support Groups.” Sociology of Health and Illness 36(1):75-90.
Levinson, Richard, Brian Powell and Lala Carr Steelman. 1986. “Social Location, Significant Others and Body Image Among Adolescents.” Social Psychology Quarterly 49:330-337.
Lewinsohn, Peter, John Seeley, Kirstin Moerk and Ruth Striegel-Moore. 2002. “Gender Differences In Eating Disorder Symptoms In Young Adults.” International Journal Of Eating Disorders 32(4):426-440.
Rouleau, Codie and Kristin Ranson. 2011. “Potential Risks of Pro-Eating Disorder Websites.” Clinical Psychology Review 31(4):525-531.