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Kempt (2002) has said that pro-ana websites may cause individuals in the early stages of anorexia to believe that anorexia is an acceptable lifestyle; in other words, they create an illusion of normalcy (this is often seen in many prevention efforts, i.e. when schools talk about suicide as if it is a normal response to stress; this leads individuals to accept suicide as an acceptable cop-out. The important thing to note is that pro-ana websites are not in the least attempting prevention of eating disorders, which highlights the dysfunctional cognitions of individuals who interact with these sites and believe anorexia is a lifestyle. They believe so because of disordered thinking and not because of backfired prevention efforts).

In 2001, the National Association of Anorexia Nervosa and Associated Eating Disorders and the National Eating Disorders Association requested that Yahoo shut down these websites. Yahoo complied, and MSN followed soon after. While this forced sites to move to different servers, these sites still exist today—they are merely underground.

Pro-eating disorder, as previously mentioned, implies a willingness to accept the eating disordered behavior without encouraging treatment and, in most cases, implies an aim to motivate continuation of disordered eating. Those who want to “adopt” the eating disordered so-called lifestyle seem to think that they can adopt and discard it at their will; however, once they become overly engrossed in their disorders, their disorder takes charge and they are no longer able to control their behaviors as they once thought they would be able to. Philosopher Kant once stated that “in order to be free, humans must transcend the domain of natural causation to which appetite belongs” (1981). While Kant simply meant acting from pure reasons alone, individuals with eating disorders seem to have taken his viewpoint quite literally.

One very ironic aspect about pro-ana websites is that they give advice on how to practice anorexia “safely,” almost as if it is a routine to go through. While anorexics identify themselves as being “ana,” they do not associate their behaviors with the disorder anorexia nervosa. Almost seems cult-like. And yet, when individuals post comments such as “I want to lose 40 pounds in two months. Help me,” they are bombarded with comments such as “We do not endorse 'wannarexics'. Go somewhere else.” Seems contradictory? It is.

In the present study, 150 participants (147 female), mainly the United Kingdom and the United States (ages 13-49) completed the EAT-26, a self-report measure disordered eating. One hundred and twenty seven reported an eating disorder (29% anorexia nervosa, 22% bulimia nervosa, 26% ED-NOS, 15% combination of AN and BN, 3% binge eating disorder, and 7% unspecific eating problems). Given the option, only 9 participants visited the pro-ana website once. Forty-one percent visited the site several times a day, and 16% visited the site at least once a day. Majority of participants found the site through internet searches and others through the media or word of mouth.

Twenty-nine percent felt the websites were harmful to them. Seventeen percent reported websites as helpful in maintaining disordered eating and 43% reported receiving emotional support from these sites.
Correlational studies found that visiting the websites frequently was correlated with subjective but not objective self-esteem improvement (r = .306, p < .005).

Those who were active site participants believed they had more in common with other visitors and felt better after visiting the sites. They were also more likely than passive participants (those who did not visit sites often) to report sites as encouraging treatment. Both actives and passives reported sites as helping them maintain their disordered eating.

The term ‘lifestyle’ can be interpreted in two ways. First, it could imply a chosen manner of living one’s life and embracing certain attitudes and behaviors that characterize or promote the lifestyle. However, it could also imply a ‘way of life’ that intrudes on every aspect of an individual’s thoughts, perceptions, and actions, without regarding personal choice in the matte.

While 54% believed anorexia and bulimia to be disorders, they also reported using them as a lifestyle that pervaded every aspect of their life; they did not, however, feel as though they were choosing this lifestyle.

While these findings suggest that these websites do offer social support, whether because of counteracting the sense of isolation that anorexics often feel or because increasing sense of relatedness among visitors, participants also reported visiting these sites to obtain information on food and exercise, thinspiration, and tips/tricks. They admitted that these websites helped maintain their disordered behaviors and that showed an overall trend of worsened body image.

Active participants reported more positive effects of the sites than did passive participants, but negative effects were equal for both; these sites were harmful regardless of frequency of visits.

While it is possible that participants were not completely honest in their responses, it is unlikely; participants freely reported that these sites enabled them to sustain their disordered behaviors. Moreover, the fact that these findings were of self-reported nature should heighten alarm around these issues—the harm that these websites are associated with is not simply an assumption of experimenters, but rather the opinion of eating disordered individuals. Assuming participants reported their true opinions, this should increase the construct validity of this study. While these data are correlational in nature and do not infer causation, the perceived impact of these sites on the well-being of individuals must be taken into consideration.

These sites will continue to appear unless a unified movement to abolish them is adopted. Shutting down one or two extremely harmful websites is not going to stop others from being created or available to individuals. Clinicians must acknowledge the effects of these sites, be aware that their patients may be visiting them often, and address these effects in treatments of patients. As clinicians begin to address these issues, society at large must work to find a loophole in the anti-censorship internet laws and demand for these sites’ removal. While this may cause patients to initially be upset due to a loss of an “important” support system, this is the only way to prevent society from dwindling into a never-ending pattern of disordered eating. This is not meant to sound overly dramatic, but simply to state the facts as they are. This is something that cannot, and should not, be ignored.

Csipke, E. & Horne, O. (2007). Pro-eating disorder websites: User’s opinions. European Eating Disorders Review, 15, 196-206.