Aside from its obvious physical manifestations, the eating disorder anorexia nervosa is a characteristically private and secretive disease. Girls suffer alone, fighting to control their body by obsessing about what they put into it. Even if parents and doctors struggle to empathize, they usually end up spending most of their time and energy worrying and trying to get the anorexic to eat. As the anorexic experiences less and less support, the victim of an already isolating disease only winds up feeling more alone.
For good and bad, the Internet has changed this basic truth. About 400 self-styled pro-anorexia (or “pro-ana”) Web sites currently exist online. They are places where girls at every stage of the disease go to seek out sympathetic sufferers and feel accepted. But what worries doctors is that the sites often encourage girls to embrace their disease, to lose even more weight, rather than seek treatment. Some of the sites describe themselves as “pro-choice” or “pro-tolerant,” and have names like “The Thin Page,” “Starving for Perfection” and “Ana by Choice.”
The tone varies from site to site, but most include the same elements: “thinspiration” photos of waifish models and actresses (Kate Moss is everywhere); tips for losing weight (“Stand up and move constantly. Obsessively tapping or fidgeting burns 10 percent more calories”); tips for hiding one’s behavior (“Leave a dirty dish lying around the house every few days for your housemates to scold you about. This is normal behavior … and it will create the illusion that you’re eating”); body-mass index counters; commandments like “Nothing tastes as good as thin feels”; daily journals; and open message boards where girls talk freely and near-anonymously about how they feel.
Operating and surfing pro-ana and “pro-ed” (for “pro–eating disorder”) Web sites may be a form of therapy for many girls, but psychotherapist Steven Levenkron, who wrote the anorexic’s bible, The Best Little Girl in the World , in 1978 and Anatomy of Anorexia in 2000, is concerned that the sites don’t address the significant gradations of the illness.
“The problem is, there are lots of girls who are very treatable,” said Mr. Levenkron. “But when they get onto these sites, they’re a little less treatable. The girls who run these sites are lonely, and instead of calling themselves sick, they get to feel like they have a career. Managing a Web site produces the illusion of managing a radio station-they feel like they’re hooked into the world. And many of them have no social life, and their only hope is to find other anorexics. But it’s negative energy coalescing: It seduces girls into anorexia, and makes the girl who runs it feel less lonely.”
“Today was harsh,” begins the journal entry of the host of a pro-ana Web site. “I was doing so well, even on the way to complete recovery. But I find myself feeling completely and utterly disgusting. I am consumed by this feeling of not being good enough and it’s killing me. I can’t get past it and I hate it. This morning was different then mornings of late, I woke up wanting to be someone else. I mean, I have always wanted to be someone else, someone better, but this time was different, terrifying. I woke up and wanted to die. I cried so horribly this morning that I think it was enough to last a thousand years. When I finally got my self composed I went to my full length mirror and lost it again. What has become of me. I have completely let myself and all my goals slip away. I am so gross.”
Most sites include disclaimers that they may “trigger” self-destructive behavior. One site hosted by an 18-year-old high-school senior in California reads: “Warning! This is a pro-anorexia site. If you have an eating disorder or feel you might otherwise be upset or triggered by the information on this site then please leave. Please do not misuse the information on this site. It is meant to help with weight loss, not suicide. Don’t let your eating disorder get out of hand. I will not be held responsible for your actions. I believe each person has to make their own choices about what they put into their body and this website is to help educate people about their options. I believe people with eating disorders should have the right to continue with their behaviors if they want. Eating disorders are coping mechanisms, albeit maladaptive ones, but usually they are a last resort. They are used when nothing else works. If you take away a person’s method of coping they will no longer be able to live. Please realize that this is not a pro-death site. It is merely to help people who suffer from anorexia find friendship in a place where they will not be judged. Understand, this is not the kind of diet you go on to lose five pounds. It is a serious illness and there are consequences to whatever choice you make. Please weigh your options carefully. Thank you.”
In July 2001, the National Association of Anorexia Nervosa and Associated Disorders asked big servers like Yahoo, which was hosting more than 100 pro-ana sites, to shut them down. They did, but it was only temporary, as the owners found other Web sites or private servers as hosts.
According to the National Eating Disorders Association, five million to 10 million girls and women, and another one million boys and men, suffer from eating disorders in the U.S. For 90 percent of women, the disease begins between the ages of 11 and 22. The disease has a 30 percent full recovery rate; between 5 and 20 percent will die from it-among the highest mortality rates of any psychological illness. Bulimia, or “mia,” tends to develop in the later teens, and is more common, affecting 1 to 3 percent of women.
A pro-ana host named Kessa said she stumbled upon her first pro-ana Web site three years ago, and that while the pictures of dangerously thin girls scared her, she felt “morbidly curious.”
“Eating disorders are often very isolating diseases, and at the time I didn’t have many friends,” said Kessa. “I was dealing with my own food issues, and becoming pro-ana seemed like a great idea. I felt it would help me make friends while making me beautiful. To this day, my favorite thing about the pro-ana world is the sense of community. We are really tight-knit. We support each other in everything, even recovery.”
Kessa said that after a while, she became desensitized to the photos of too-thin women and convinced herself that they were beautiful.
“I would stare at these models and tell myself over and over again that they were beautiful and perfect, and that I could be just like them. Eventually, even very emaciated girls didn’t scare me,” she said.
She kept a journal online that led her to start a pro-ana site. She had to change the site’s address every time her parents discovered it, but as soon as she turned 18, she got a credit card and purchased her own domain.
“My goal with my Web site is to make people with eating disorders feel less alone and to be able to make the choice not to get better-and still be accepted in at least one place in our judgmental world,” said Kessa.
Clara (not her real name) said that she’s been anorexic since she was 3, and that she got it from her mother, who used to cook her tons of food but never ate any of it. Clara goes to college in New York and works part-time as a makeup artist in a department store. She has a boyfriend, but only one female friend. She runs a pro-ana site.
“I really, really like it because it’s something to belong to, and you can meet new people every single day,” said Clara. “Someone will just I.M. you and say, ‘Do you want to start a fast on the same day?’, and you talk to each other about the fast and how it’s going and if we’ve allowed ourselves to eat. And if we decide to allow ourselves to eat one carrot, we’ll eat the carrot together.”
Dr. Rachel Russell, a clinician who specializes in eating disorders in Danbury, Conn., sees the pro-ana sites as an honest expression of what anorexia is, complete with the ambivalence.
“There’s some desire for community,” said Dr. Russell. “But there’s also a kind of wanting to smear their pain, like, ‘Look at this-I’ll make you look at this!’ This is because a lot of important people in their lives aren’t recognizing their pain.”
She thinks it would be a mistake to outlaw the sites.
“When you have an eating disorder, being able to articulate anything about the experience is valuable on some level,” she said. “I also think it’s valuable for people to have access to other people’s experiences-it can have the effect of seeing oneself in a mirror.”
Holly Hoff, the director of programs at the National Eating Disorder Association, disagrees. She wants the sites banned.
“We recognized right away that the fact that this information was on the Internet was like putting a loaded gun in the hands of someone who’s suicidal,” said Ms. Hoof. She added that the sites are increasing the stress on girls who literally may be dying to be thin.
Nora (not her real name) is a 16-year-old junior in high school in New York, who said she’s been posting on pro-ana sites since her mother got the Internet last year. She was very clear about what led her to her anorexia: two instances of abuse when she was a child. She explained that because she was hurt, she feels entitled to keep on hurting.
“It’s a selfish thing,” said Nora. “I just want to suffer right now. I don’t want to die-I just want to express my hurt.
“It’s too personal in real life,” she continued. “So by putting it online, I feel like I can detach it enough and get it out and feel better about it without having to comfort somebody else in person. Because I’m not emotionally stable enough to do that, and neither are they.”
Nora said she has no desire to meet the people she talks to online, because she’s scared of finding out they lied.
“I’m afraid of finding out that someone who talked to me and comforted me and related to me is a fat girl,” she said.
Nora divided anorexics into three general groups: “There are suicidals, who are just barely committing to living; the people who are in denial and don’t think they’re going to die; and the people like me, who realize there’s a problem and don’t know how to get over it,” she said.
What they all have in common is a generational facility with computers and the Internet that allows them to evade their parents’ scrutiny. One Web site cautions: “DESTROY ALL EVIDENCE …. Sign out of your mailbox and clear the history before you get off of the Internet. You know how the address fills itself in automatically sometimes? Imagine a link to http://www.anorexicweb.com popping up when you’re [ sic ] mother’s trying to rent a car online.”
Nora said she uses a secret e-mail address to talk to people, and surfs the Web with a browser her mother doesn’t realize is on their computer.
“She’s not that into the computer,” said Nora. “She’s an accountant who should have been a dancer, and that’s all she talks about.”