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Pro-Anorexia Websites: Promulgating a deadly lifestyle
Kristin L. Bater
December 12, 2010
*These images are examples of “thinspiration”. They were taken from ceruleanbutterfly.com, a site that was previously associated with the pro-anorexia movement. This site now claims to serve as an informational resource about eating disorders.
The internet is a source of unlimited information to which, due to the ever-advancing field of technology, individuals have constant access. Furthermore, the internet provides a seemingly confidential setting in which information can be sought. According to Gray and Klein (2006), adolescents are using the internet as a means of seeking information about both health and sexuality – primarily through the use of common search engines. While the internet can undoubtedly be used as a resource for health related issues and questions, its uncensored nature poses a risk to adolescents surfing for answers – especially those in search of information about anorexia nervosa. Aside from providing users with helpful information about this potentially fatal medical condition, the internet is also being used to promote the “thin-ideal” (Bardone-Cone et al. 2007).
If someone were to enter “anorexia” into any major search engine, they would certainly be directed to sites providing useful and factual information. However, some of the links would connect them to sites that promulgate the “pro-anorexia” movement. Pro-anorexia websites are sites that embrace and endorse anorexia nervosa as a conscious lifestyle choice, rather than a medical condition (Bardone-Cone et al. 2007). These sites provide a network of support for individuals struggling with anorexia nervosa (Harper et al. 2008). A study conducted by Norris et al. (2006) attempted to identify pro-anorexia websites and to describe their contents. It was found that these websites all possessed similar characteristics such as: tools for calculating Body Mass Index (BMI) or Basal Metabolic Rate (BMR), and “thinspiration” – photos, quotes, and writings meant to inspire individuals on their quest for thinness. These sites also commonly posted tips and tricks involving ways to restrict caloric intake and conceal weight loss or destructive behaviors. General themes among these websites were: control, success, perfection, sacrifice, deceit, transformation, isolation, coping, solidarity, and revolution.
To summarize, pro-anorexic websites define and promote anorexia as a conscious choice and lifestyle and provide a means of support, encouragement, and techniques for individuals striving for this extreme level of thinness (Bardone-Cone et al. 2006). While the purpose of these sites can be identified, as it is often plainly stated on their home pages, the impact of visiting these pro-anorexia websites on body dissatisfaction, self-esteem, and disordered eating among their visitors is not well studied. The goal of this review is to analyze the existing literature to determine the consequences of visiting a pro-anorexia website.
The Effects of Pro-anorexia Websites
Study 1: “Viewership of Pro-Anorexia Websites in Seventh, Ninth and Eleventh Graders”
In 2007, a study by Custers and Van de Bulck utilized a 50 minute questionnaire to assess the prevalence of pro-anorexia websites in 711 teens, ranging in age from thirteen to seventeen. The findings were then geared toward evaluating if the viewership of these sites was a predictor in the development of anorexia nervosa. Due to the large age range – from thirteen to seventeen-years old – and the fact that both females and males participated in this study, the data was adjusted for potentially confounding factors. Following the assessment of those who had visited these sites, the Eating Disorder Inventory (EDI) (Garner, Olm- stead, & Polivy, 1983) was used to assess drive for thinness and perfectionism. Students were also asked to report their body mass index. The self-description questionnaire (Marsh 2006) was also given to assess perception of appearance in the students. From this study, it was gathered that, between all grade levels, 12.6% of girls and 5.9% of boys had visited these sites. Furthermore, the effects of visiting these sites in girls were correlated with higher drive for thinness, lower perception of appearance, and higher rankings in perfectionism. There was no further analysis of the effects on the male participants because of the low prevalence of visitation.
This study, in utilizing school-wide participation, was designed to gage the effects of these pro-anorexia websites on individuals with and without high risk. It also examined three different cohorts through cross-sectional data, which is also beneficial when considering the specific effects that these websites might possess within certain age groups. Both males and females were surveyed and the prevalence of visitation was measured for both groups. It was noted by the authors that this study did possess certain limitations due to its cross-sectional nature – the biggest issue being the variation in visitation of these sites between the genders and the ages. Another drawback of this particular study is the fact that it relied completely on the participants’ honest answers to survey questions. As noted in the discussion section, it is possible that the negative stigma often attached to eating disorders caused participants to not answer truthfully about having visited pro-anorexia websites. Therefore the true prevalence of visiting these sites is higher than reported and thus, these sites are having a greater impact than is presently being accounted for.
Study 2: “Surfing for Thinness: A Pilot Study of Pro–Eating Disorder Web Site Usage in Adolescents With Eating Disorders”
In 2006 a pilot study was conducted, by Wilson et al., that utilized cross-sectional data to assess the prevalence of visitation of pro-anorexia websites in adolescents with eating disorders. This study also aimed to measure the parental knowledge of pro-anorexia website usage. This particular study sent anonymous surveys to 698 families; 182 people returned their surveys, this group included both the adolescents with eating disorders and their parents. The findings reported that 52.8% of parents were aware that pro-eating disorder websites existed, but did not know that their child was visiting such sites. Only half of the parents who were aware of these sites discussed their existence with their children. This study also acknowledged the existence of pro-recovery websites – a facet not present in other research. While nearly half (47.8%) of the subjects did not visit pro-anorexia or pro-recovery sites, the individuals who did visit these sites reported learning new weight-loss or purging techniques 96.0% of the time on pro-anorexia websites and 46.4% of the time on pro-recovery sites – showing that the viewing of these sites is not without consequence.
While this study examines the effects of websites containing information about eating disorders – both pro-eating disorder and pro-recovery – on patients who had previously been diagnosed, this was also a source of weakness in their methods. While these sites may or may not have a different impact on those diagnosed with an eating disorder and those individuals without such diagnoses, it is important to remember that the content of these websites can be accessed by all individuals, and thus the impact of this information should be measured across all groups – not just those already diagnosed or identified as high risk. However, a strength of this study was that the author acknowledged the presence and impact of pro-recovery sites, as well as pro-eating disorder sites. This brought about an important correlation: overall, visitors of both pro-anorexia and pro-recovery sites were hospitalized more than non-viewers. The inclusion of pro-recovery websites in the study gives rise to an important relationship between websites containing any eating disorder content and their impact on hospitalization that should and could be further analyzed.
Study 3: “Viewership of Pro-Eating Disorder Websites: Association with Body Image and Eating Disturbances”
In 2008, Harper et al. conducted a study that evaluated the effects of pro-anorexia websites on individuals’ body dissatisfaction and eating disturbance. This study was performed on a much larger scale than the previous two studies – it included 1,575 female participants, all of whom were undergraduates in the psychology department at the University of South Florida. Each of these women was surveyed about whether or not they had visited one of three types of sites: pro-anorexia, pro-recovery, or simply a professional site with information about eating disorders. If they responded yes to visiting a site in any of these categories, they were asked for the specific site. Data collection continued for one year and the women received course credit for their participation.
After one year of data collection, it was reported that only 13% of the women surveyed reported visiting a site containing content about eating disorders. The percentage of women who had visited pro-recovery sites was so low that this group was not further analyzed. For the purposes of this study, the authors chose to focus on “pure viewership” – the viewing of only one type of site, either pro-anorexia or professional – so that comparisons between the two groups could be drawn. They also utilized the women who did not report visiting any of these sites (n=1376) as a control group. A three-way ANOVA was performed that assessed the following variables: Appearance Evaluation, Drive for Thinness, Bulimia, and Body Dissatisfaction. Body satisfaction was measured using the Multidimensional Body-Self Relations Questionnaire- Appearance Evaluation Subscale and the latter three variables were measured using the Eating Disorder Inventory. Body Mass Index was also measured and included in the ANOVA comparison of the groups. Based on the data collected in this study, the authors found that BMI was not significantly different between the three groups. In appearance evaluation, the pro-eating disorder group had higher body dissatisfaction than the control but that the pro-eating disorder and the professional eating disorder site viewers were not significantly different in their body dissatisfaction. The EDI showed a similar trend, in that the groups that viewed both the pro-eating disorder websites and the professional eating disorder sites showed higher levels of eating disturbed behaviors. The author also notes separately, likely as a means of supporting levels of body dissatisfaction amongst the women who had visited both pro-ED and professional sites, these women viewed cosmetic surgery websites at rates of 37% and 31%, respectively, compared to the control group at 16%.
Based on the information garnered in this study, the author concludes that the women who frequented pro-eating disorder websites had higher levels of body dissatisfaction and eating disturbance than the control group. However, the author also notes that there is not sufficient evidence to distinguish the effects of pro-ED websites and the effects of professional websites containing information about eating disorders.
This study was strong due to its large sample size and comparison of three separate groups – pro-ED viewers, professional information viewers, and non-viewer (control) group. However, the author notes that the study was still limited, despite the fact that the sample size exceeds those of previous studies, because the sample size for groups visiting pro-ED sites was still small. Due to the random nature of the study, as it was based solely on volunteer participation, varying levels of exposure to pro-eating disorder sites and previous eating disturbance were not accounted for. Additionally, the author notes that studies involving pro-eating disorder sites should be of some concern as they pose the risk of exposing individuals to this type of information for the first time. It is also suggested, in the conclusion section of this experiment, that a prospective study be designed in order to gage levels of eating disturbance in participants prior to and after the viewership of pro-ED or professional information sites to more accurately assess their effects.
Despite the small amount of literature that exists about the effects of viewership of pro-anorexia content online, important information can be extracted and conclusions can be drawn from the three studies summarized in this review. The first is that viewing pro-anorexia websites augments body dissatisfaction and eating disturbance. In all three studies, the individuals who frequented pro-anorexia sites reported increased body dissatisfaction and disorder eating, as measured by either the Multidimensional Body-Self Relations Questionnaire - Appearance Evaluation Subscale or the Eating Disorder Inventory.
Secondly, these studies highlight the varied age groups that are impacted by pro-anorexia websites. In the first study, students aged thirteen to seventeen were surveyed and in each of the age groups – 13, 15, and 17 – there were at least 5% who had visited a pro-anorexia website. In the second study, both adolescents and parents were surveyed. Results found that 52.8% of parents were aware of these sites and that more than half of the adolescents surveyed had visited a website that contained information pertinent to eating disorders - either a pro-anorexia or pro-recovery site. The third study had no age limitations and thus the sample size included individuals with ages ranging from 18-61, with a mean age of 21-years-old – from which 13% had visited a site related to eating disorders. This demonstrates that due to the availability of these sites, they have the potential to impact individuals of all ages, which should make their level accessibility a concern. It is also noted that these prevalence rates are likely lower than the actual prevalence of visitation of such sites due to the negative stigma often associated with eating disorders – potentially making individuals who participated in these surveys less willing to admit having visiting one of these sites. For future research, it would be beneficial to contact webmasters in order to assess the true prevalence of visitation of these sites based on the number of hits they receive.
Another point of interest that is raised in the second and third studies is the effect of pro-eating disorder websites versus professional websites containing information about eating disorders. In both of these studies, the effects between these two sites, although their purposes are vastly different, were not significantly different. Both pro-ED and professional sites caused measured increases in body dissatisfaction and eating disturbance. This indicates that perhaps access to professional information sites should also be restricted as they appear to have equally negative effects on individuals that view them.
Due to the fact that the breadth of literature spanning this topic is very limited, it is difficult to make any definite conclusions about the effects of pro-anorexia websites. However, the few studies that have been conducted all show some correlation between body dissatisfaction and eating disturbance and the viewership of pro-anorexia content. Because the internet provides unlimited opportunities for this content to be accessed, it would be beneficial to further investigate if these sites are truly working to promulgate this deadly lifestyle.
Bardone-Cone A.M., Cass K.M. (2006). Investigating the Impact of Pro-Anorexia Websites: A Pilot Study. International Journal of Eating Disorders, 14, p.256–262.
Bardone-Cone A.M., Cass K. M. (2007). What Does Viewing a Pro-Anorexia Website Do? An Experimental Examination of Website Exposure and Moderating Effects. International Journal of Eating Disorders, 40, p.537–548.
Custers K., Van de Bulck J. (2009). Viewership of Pro-Anorexia Websites in Seventh, Ninth and Eleventh Graders. European Eating Disorders Review, 17, p.214-219.
Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2, p.15–34.
Gray N., and Klein J. (2006). Adolescents and the Internet: health and sexuality information. Current Opinion in Obstetrics & Gynecology, 18(5), p.519-524
Harper K., Sperry S., Thompson J.K., (2008). Viewership of Pro-Eating Disorder Websites: Association with Body Image and Eating Disturbances. International Journal of Eating Disorders, 41, p.92-95.
Marsh H.W., Parada R.H., Ayotte V. (2004). Self-description questionnaire II. Psychological Assessment, 16(1), p.27-41.
Norris M.L., Boydell K.M., Pinhas L., Katzman D.K. (2006). Ana and in Internet. International Journal of Eating Disorders, 39, p.443-447.
Wilson J.L., Peebles R., Hardy K.K., Litt I.F. (2006). Surfing for Thinness: A Pilot Study of Pro–Eating Disorder Web Site Usage in Adolescents With Eating Disorders. Pediatrics, 118(6), p.1635-1643.
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