What about information on the Internet? Are Web sites about anorexia helpful or harmful?
The good news about online health information is that the Internet can indeed be a useful tool for better understanding anorexia, learning about treatment options, and locating community support. Proactive eating disorders organizations such as the Academy for Eating Disorders (AED), the National Association for Anorexia Nervosa and Associated Disorders (ANAD), and the National Eating Disorders Association (NEDA) maintain helpful Web sites that provide information and resources for anorexia patients and their loved ones, as well as for the public.
The Internet is also fast becoming a treatment tool. Although research in this area is limited, preliminary results show that certain forms of Internet-based intervention may provide a future complement to traditional face-to-face treatments. Unfortunately, while there are many Internet sites that offer practical and helpful information about anorexia, there are also numerous Web sites that host just the opposite, offering information that is inaccurate, misleading, and even dangerous.
The past decade has witnessed a surge of popularity in a genre of Web sites referred to as “Pro-Ana” (pro-anorexia) and “Pro-Mia” (pro-bulimia) in their content (Shepphird 2007). Users and hosts alike are predominantly teenage girls who engage in unhealthy dialogue about anorexia nervosa, body image, and other issues related to disordered eating.
Alarmingly, one of the main ideas promoted on these Web sites is that anorexia is a lifestyle choice, not an illness. Eating disorders are heralded as a means of achieving “perfection,” and attempts are made to aid others in disordered behaviors by providing information about purging agents, ideas for severely restricting food intake, and “tips” for “staying strong” in the quest for the “perfect” body. Slogans, poems, personal stories, and photographs of dangerously underweight women and men are offered to visitors as “thinspiration” for anorexic behaviors. Hosts and visitors alike share thoughts on ways to keep their behaviors hidden from loved ones, oppose intervention from healthcare professionals, and refuse family involvement in recovery. The proliferation of these Web sites is of great concern. In addition, Pro-Ana content is popping up on popular social networking sites such as MySpace and Facebook, technologies used by upwards of 80-96% of all 12- to 17-year-olds.
A recent study published in the medical journal Pediatrics showed that teens looking for eating disorders information on the Internet are more likely to be hospitalized for their condition than teens who do not seek such information online.
Results of a 2007 study published in the International Journal of Eating Disorders found that after just a single viewing of a pro-anorexia Web site, participants reported lower self-esteem, perceived themselves as heavier, and said they were more likely to think about their weight in the near future.
For many visitors, these Web sites can create an artificial sense of community by offering a seductive sense of camaraderie and belonging. They encourage users to wear solidarity bracelets to affirm their “membership” in the pro-eating disorders community: a red bracelet for anorexia, purple for bulimia, and green for EDNOS.
One site welcomes visitors with warm comments such as, “Good luck! Hugs and kisses,” and one user writes, “This is truly one of the most accepting, close-knit communities of any on the net.” “Please Ana [a reference to anorexia], don’t give up on me,” states a Pro-Ana blogger, “all that’s important is that you love me. Today, I renew our friendship and resolve to be faithful to you.”
In February 2008, in the United Kingdom, 40 Members of Parliament signed a motion urging government action against Pro-Ana sites. The motion was timed to coincide with the U.K. National Eating Disorder Awareness Week. In April 2008, a French bill was introduced that would outlaw material that” provokes a person to seek excessive thinness by encouraging prolonged restriction of nourishment.” In America, organizations such as ANAD have had some limited success removing pro-anorexia Web sites from Internet search engines. For parents and loved ones, there are ways to minimize the negative effect of these sites. First, if you suspect that your child may be involved in the pro-anorexia movement, talk openly about it. Ask questions about the sites your kids visit online. Inform any Pro-Ana Web site users in your family about Web sites that promote recovery from eating disorders as a healthy alternative. These Web sites have been a source of support for those recovering after being a part of the pro-anorexia community. One of these Web sites is www.WeBiteBack.com
Second, parents with teens at high risk for an eating disorder may want to consider utilizing Internet parental controls, in the same way that you might block Web sites with adult content from your home computer. You may wish to keep home computers in a common area to monitor online activity. Studies show that three-fourths of teens report that their parents “almost never” monitor the Web sites they use or the time they spend online, and one-third of teens report that their parents know “very little” about what they do on the Internet. Third, be sure to stay involved in your child’s recovery, be informed,
maintain open dialogue about your child’s need for community, and promote healthy ways of building self-esteem. Fourth, while the Internet can be a useful tool for locating eating disorders recovery resources in your community, it is important to distinguish between accurate, helpful information and information that can have a detrimental effect. If you are unsure of the accuracy of any anorexia information you find online, ask your healthcare professional.
Pro-Anorexia Web Site Content
Many of the pro-anorexia Web sites share certain features, two of which are “Ana’s Creed,” eight beliefs subscribed to by pro-anorexia Web hosts, and the “Thin Commandments,” a set of ten “rules” to follow for achieving an anorexic “lifestyle.”
Ana’s Creed
• I believe in Control, the only force mighty enough to bring order to the chaos that is my world.
• I believe that I am the most vile, worthless, and useless person ever to have existed on the planet and that I am totally unworthy of anyone’s time and attention.
• I believe that other people who tell me differently are idiots. If they could see how I really am, then they would hate me almost as much as I do.
• I believe in perfection and strive to attain it.
• I believe in salvation through trying just a bit harder than I did yesterday.
• I believe in bathroom scales as an indicator of my daily successes and failures.
• I believe in hell because I sometimes think that I am living in it.
• I believe in a wholly black and white world, the losing of weight, recrimination for sins, abnegation of the body, and a life ever-fasting.
The Thin Commandments
• If you are not thin, you aren’t attractive.
• Being thin is more important than being healthy.
• You must buy clothes, cut your hair, take laxatives, starve yourself, and do anything to make yourself look thinner.
• Thou shall not eat without feeling guilty.
• Thou shall not eat fattening food without punishing oneself afterwards.
• Thou shall count calories and restrict intake accordingly.
• What the scale says is the most important thing.
• Losing weight is good; gaining weight is bad.
• You can never be too thin.
• Being thin and not eating are signs of true will power and success.
Does substance abuse commonly co-occur with eating disorders such as anorexia?
“For many young women, eating disorders like anorexia and bulimia are joined at the hip with smoking, binge drinking, and illicit drug use,” states Joseph A. Califano, Jr., the former U.S. Secretary of Health, Education, and Welfare. Indeed, scientific studies confirm that substance abuse and eating disorders do appear to be closely linked. A 2004 review conducted by The National Center on Addiction and Substance Abuse (CASA) at Columbia University revealed that up to one-half of individuals with an eating disorder abuse alcohol or illicit drugs. However, studies show that there is a lower rate of drug and alcohol abuse among patients with anorexia nervosa than with some other eating disorders. According to the Clinical Manual of Eating Disorders, the rate of substance related disorders among anorexia patients ranges between 10-33%. The risk is reportedly higher among anorexia patients with the binge/purge subtype than among restricting-type anorexia patients.
The CASA report points to shared risk factors that exist both for substance abuse as well as for eating disorders. These factors include life stressors, family history, mood disorders, low self-esteem, social pressures, and susceptibility to messages from advertising and the media. In addition, the report notes shared characteristics of the two afflictions, namely secretiveness, social isolation, compulsive behaviors, and the life threatening nature of both conditions. Substances that pose the greatest risk for abuse among eating disorder patients are caffeine, tobacco, alcohol, diuretics, laxatives, emetics, amphetamines, cocaine, and heroin.
Term:
Amphetamines – A class of drugs that has a stimulant effect on the central nervous system of the body.
