Web sites that promote anorexia raise concern

Jul 3 2010

For women with low self-esteem, poor body image and a certain genetic predisposition towards an eating disorder, the messages promoted on pro-eating disorder web sites can be similar to someone considering suicide finding a loaded gun on her pillow.

Recent efforts to raise awareness of pro anorexia and bulimia web sites often pay little attention to deaths that may result from the actions of the web site operators, according to Dr. Kimberly Dennis, M.D., a psychiatrist specializing in eating disorder treatment. Dr. Dennis, Medical Director at Timberline Knolls Residential Treatment Center and a leader in treatment for anorexia and bulimia, has particular concern about "pro ana" web sites.

"It disturbs me how aggressively some of these web sites promote anorexia as a lifestyle choice, and how intricately they scheme to subvert the efforts of families and treatment providers trying to save the lives of those with anorexia," Dr. Dennis said. "Press coverage of these sites often completely ignores the reality that anorexia nervosa has the highest mortality rate of any mental illness – up to 20%. This is a life and death matter that families and individuals facing eating disorders must recognize."

A new study published by the American Journal of Public Health looked at 180 of these pro-ana and pro-mia (sites promoting bulimia nervosa) web sites and found 83 percent of them offered advice on both how to start an eating disorder and/or how to continue the progression of anorexia, bulimia, or other eating and exercise disorders.

Dr. Dennis shares the frustration of many in the eating disorder treatment community who wish more could be done to stop these harmful messages from reaching vulnerable girls, boys, women and men. She noted, "While the lack of available data has made it impractical to quantify the direct impact of pro-ana and pro–mia web sites on the rates of mortality among their users, it's clear from clinical experience that these sites feed these deadly diseases instead of supporting recovery."

Pro eating disorder web sites take a variety of tactics to sell anorexic or bulimic behaviors as desirable. Many times "thinspiration" is used, commonly in the form of images or videos of slim women that promote the mindset that thinness equals happiness and success. "We've seen it a lot at Timberline Knolls. Many of our residents with anorexia and bulimia, including young girls, college students and even some women in their 50's and 60's, have been involved in pro-ana web sites," said Dr. Dennis.

Pro ana and pro mia web sites also provide advice on how to hide signs of eating disorders from loved ones and healthcare providers. This can encourage women to continue eating disorders that might otherwise have been successfully treated. "Some anorexic and bulimic residents have told us how they previously created their own blogs about how to be more effective in their eating disorders, and others use Facebook accounts to document their diseases with both words and pictures," said Dr. Dennis.

Timberline Knolls Residential Treatment Center works to strengthen women and girls from within so they can live empowered lives and abstain from the pro ana and pro mia communities, which may lure them back into the grips of a deadly disease. "Leaders on these web sites cultivate a close community that can be very compelling to a woman struggling to feel connected to others around her," said Dr. Dennis. "The Timberline Knolls treatment program, with its strong emphasis on spirituality, 12-step recovery and dialectical behavioral therapy, intervenes on this front. We support each resident in making the choice to connect with others in the service of her recovery rather than to feed her disease."