tag:theconversation.com,2011:/global/topics/pro-ana-websites-9299/articlesPro-ana websites – The Conversation2017-06-22T20:05:23Ztag:theconversation.com,2011:article/791972017-06-22T20:05:23Z2017-06-22T20:05:23ZShould ‘pro-ana’ websites be criminalised in Australia?<figure><img src="https://images.theconversation.com/files/174653/original/file-20170620-24868-a5sy3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Australia, there is little regulation of pro-ana material.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Anorexia nervosa is a mental illness characterised by a distorted body image, an extremely low body weight, and a <a href="https://www.eatingdisorders.org.au/eating-disorders/anorexia-nervosa">fear of gaining weight</a>. While anorexia affects all people, it is significantly more prevalent among women.
Even though it is relatively rare, its effects are devastating. </p>
<p>Anorexia is <a href="https://www.ncbi.nlm.nih.gov/pubmed/23625628">notoriously difficult to treat</a>. Across all mental illnesses, it has <a href="http://www.tc.columbia.edu/publications/gsjp/gsjp-volumes-archive/36307_6Johnson.pdf">the highest rate of mortality</a>, so research in this area is crucial. </p>
<p>It is not possible to determine a single cause of anorexia. Nevertheless, risk factors associated with the disease are well known. These include genetics, psychological predisposition, and social or cultural factors.</p>
<p>Increasingly, our social and cultural interactions take place online. It is, therefore, not surprising that online interactions intersect with mental illnesses generally, and anorexia specifically. This is particularly when taking into account that the average person who suffers from anorexia tends to be relatively young.</p>
<p>“Pro-ana” websites endorse anorexia as a positive choice, as opposed to a mental illness. Other variants include “pro-mia” websites, which endorse bulimia. These sites predominantly target women. </p>
<p>They promote a very thin body as the type that women must have. They give advice about how to become anorexic, how to hide an eating disorder from others and how to diet. The websites contain images of extremely thin women, which are sometimes altered to make the women appear thinner.</p>
<p>These websites have a long history. In 2001, Time Magazine noted the existence of <a href="http://content.time.com/time/health/article/0,8599,169660,00.html">400 such sites</a>. Efforts to eradicate these sites are just as old. AOL and Yahoo <a href="https://hal.archives-ouvertes.fr/hal-00780295/document">tried to ban pro-ana material that same year</a>. </p>
<p>These attempts have not been successful. Rather, the “survival” of such networks has required adaptation.</p>
<p>In practice, this involves these networks “<a href="https://hal.archives-ouvertes.fr/hal-00780295/document">turning inwards</a>”, as “subgroups of ana-mia bloggers will exchange messages, links and images among themselves and exclude other information sources”. Present estimates suggest there may be millions of pro-ana websites. </p>
<p>Like other online interactions, pro-ana websites have become integrated with social media. </p>
<h2>The present legal framework</h2>
<p>In Australia, there is little regulation of pro-ana material. There are general criminal offences that relate to <a href="https://www.slp.wa.gov.au/statutes/swans.nsf/%28DownloadFiles%29/Criminal+Code.pdf/$file/Criminal+Code.pdf">causing bodily harm</a>. This includes causing a person to have a disease or disorder. It follows that anorexia, while a mental illness, might nevertheless constitute bodily harm.</p>
<p>However, it is not likely that these offences will criminalise the publication of pro-ana material. The causes of anorexia are complex and multifaceted. Criminal prosecution usually requires proof that an action caused a particular outcome. Where many complex factors contribute to an outcome, it is difficult to prove causation in a criminal court.</p>
<p>Some jurisdictions have offences of “<a href="https://www.slp.wa.gov.au/statutes/swans.nsf/%28DownloadFiles%29/Criminal+Code.pdf/$file/Criminal+Code.pdf">hastening death</a>”. These provisions criminalise making a “<a href="https://jade.io/j/?a=outline&id=10782">substantial contribution</a>” to a death. Where it can be shown that pro-ana material contributed to death, by accelerating the progression of anorexia for example, criminal liability may follow. However, prosecution in such a case remains very difficult.</p>
<h2>The French legislation</h2>
<p>France has been an international leader in <a href="http://researchonline.nd.edu.au/cgi/viewcontent.cgi?article=1011&context=undalr">laws that relate to body image</a>. In 2015, the French government modified its Public Health Code to include an article that states:</p>
<blockquote>
<p>[c]ausing a person to seek excessive leanness by encouraging prolonged food restrictions which result in exposing the person to life-threatening danger or in directly compromising their health, is punishable by one year in prison and a fine of €10,000.</p>
</blockquote>
<p>The French MPs who proposed the law, Maud Olivier and Catherine Coutelle, <a href="http://www.dailymail.co.uk/news/article-3023026/France-cracks-pro-anorexia-websites-encourage-young-women-weight-low-possible.html">stated that</a> “certain sites known as pro-ana can push people into a vicious circle of anorexia and authorities cannot do anything about it”.</p>
<p>Other countries have also <a href="http://www.thedailybeast.com/articles/2014/08/30/should-pro-ana-sites-be-criminalized.html">proposed similar bans</a>. In Australia, former federal MP Anna Burke has advocated following France’s lead and <a href="http://www.smh.com.au/news/national/call-to-ban-anorexia-websites/2008/04/16/1208025283081.html">banning such websites in Australia</a>.</p>
<h2>Issues with criminalisation</h2>
<p>Pro-ana websites are commonly interactive. The line between a consumer and a producer of social media is blurry. Laws to prohibit pro-ana material would likely also capture the behaviour of visitors to these sites who interact with them. </p>
<p>A considerable proportion of women who seek out pro-ana websites report suffering from an eating disorder. Visitors to these websites commonly report that they are seeking support in relation to those disorders, often after traditional therapies have been unsuccessful. </p>
<p>Similarly, most publishers of pro-ana websites are women who themselves suffer from the illness. If creating pro-ana websites is criminalised, then it could make it more difficult for the creators to seek the help that they need to recover. </p>
<p>Much of the content of pro-ana websites is shocking. Telling readers to “stop eating until they take you to the hospital” is disturbing. This line might be hyperbole. It might be evidence of the disordered thinking typical of anorexia. In either case it evokes a strong reaction.</p>
<p>Yet, similar material is found elsewhere in the public space. The common pro-ana motto, “nothing tastes as good as skinny feels”, is attributed to <a href="http://www.independent.co.uk/news/people/news/kate-moss-in-quotes-nothing-tastes-as-good-as-skinny-feels-and-other-career-defining-statements-by-9061975.html">supermodel Kate Moss</a>. That line, and variations on it, are used in <a href="http://melindatankardreist.com/2012/04/nothing-tastes-as-bad-as-lorna-jane-co-opting-pro-anorexia-slogan-for-ad-campaign/">marketing material by clothing retailers</a>. </p>
<p>Images used by pro-ana websites are most often taken from other sources. They include photos from fashion and women’s magazines, celebrities and well-known models. These images – shocking in the context of pro-ana websites – are ubiquitous in the public space.</p>
<p>Public comment advocating extreme thinness in women is also common. Radio shock-jock Kyle Sandilands used his nationally syndicated show to tell a woman: <a href="http://www.dailymail.co.uk/tvshowbiz/article-3700555/Overweight-Kyle-Sandilands-says-likes-women-starving-look-fat-shames-Adele.html">“I like the starving look … 60kgs is pushing it.”</a> </p>
<p>Internationally syndicated celebrity MD Dr Oz’s show is broadcast on free-to-air TV in Australia. It featured Camille Hugh’s book, The Thigh Gap Hack. That book promised women “the shortcut to slimmer, feminine thighs every woman secretly desires” by techniques such as the trademarked “hunger training”. This technique encourages women to skip meals and instead “listen” to their body for signals of “true” hunger. </p>
<p>Proposals to criminalise pro-ana websites would make it an offence to collect and collate images, slogans and “tips” that are commonly used to market to women. These laws would criminalise this behaviour when done by women in a pro-ana context, but not when done to women. This seems deeply problematic.</p>
<h2>Alternatives to criminalisation</h2>
<p>The alternative to criminalisation is to use online platforms to deliver health information. For example, searching “pro-ana” on social media site tumblr returns the following page:</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/174641/original/file-20170620-10641-njuusd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/174641/original/file-20170620-10641-njuusd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=634&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174641/original/file-20170620-10641-njuusd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=634&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174641/original/file-20170620-10641-njuusd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=634&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174641/original/file-20170620-10641-njuusd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=796&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174641/original/file-20170620-10641-njuusd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=796&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174641/original/file-20170620-10641-njuusd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=796&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Social media website tumblr offers support to users who search common pro-ana terms.</span>
<span class="attribution"><span class="source">from www.tumblr.com</span></span>
</figcaption>
</figure>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/24132789">Research on internet search habits</a> found that explicit reference to a celebrity’s eating disorder in traditional media reports decreased the rate at which people searched for material relating to anorexia. This suggests that alternative messaging, rather than criminalisation, may have merit. </p>
<p>Another possible alternative is to add some sort of warning on these pages about the dangerous content and the harm that may come from viewing them. </p>
<hr>
<p><em>If you, or anyone you know, is suffering from an eating disorder, you can <a href="https://thebutterflyfoundation.org.au/">contact the Butterfly Foundation</a> for assistance by calling 1800 334 673.</em></p><img src="https://counter.theconversation.com/content/79197/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tomas Fitzgerald has received funding from the WA Bar Association. He is a member of WA Labor.
</span></em></p><p class="fine-print"><em><span>Marilyn Bromberg has received funding from the Telethon-Perth Children's Hospital Research Fund, as part of a research team. She volunteers as a lawyer for the Fremantle Community Legal Centre and as a judge for the mock trials of high schools students, organised by the Law Society of Western Australia. </span></em></p>Criminalising websites that celebrate extreme, unhealthy thinness is deeply problematic.Tomas Fitzgerald, Senior Lecturer in Law, University of Notre Dame AustraliaMarilyn Bromberg, Senior Lecturer in Law, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/399542015-04-20T11:27:51Z2015-04-20T11:27:51ZAnorexia is an illness – not something we can simply blame on the media<figure><img src="https://images.theconversation.com/files/78251/original/image-20150416-5628-14ymst7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Catwalk size doesn't affect anorexia as much as you think.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/koreanet/7689308828/in/photolist-cHtHC9-5Vm95E-j6vLUv-9jFogt-aDco7G-bUVt7s-pRd5yU-cofdTJ-k1ZT9-nPWf7d-3Yf4Q7-bUY7gY-bUY7b3-bUY6ZJ-bUY6Eb-bUY6xm-bUY6SE-fpurmy-fpur7W-4887rG-fpfc2K-fpfbpz-5kJzSp-8K1bYV-8K1bWe-5WrwGj-3QdYq">Republic of Korea</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>France has joined Italy and Israel in passing laws <a href="http://www.telegraph.co.uk/news/worldnews/europe/france/11514613/France-divides-the-fashion-world-by-banning-skinny-models.html">banning the promotion of extreme thinness</a> in the fashion industry. The health reforms, which include fining agencies employing models with a BMI under 18 and criminalising <a href="https://theconversation.com/anorexia-advocates-turn-medical-condition-into-self-expression-23955">pro-anorexia web content</a>, have now passed through the upper house of parliament. </p>
<p>An <a href="https://theconversation.com/weighing-the-evidence-for-banning-skinny-catwalk-models-39043">analysis of the reforms by Sarah Jackson</a> on The Conversation suggested that censoring images of ultra-thin models may ease their adverse effects on young women, such as concerns about body image and behaviours such as unhealthy eating. </p>
<p>But while some have been hailing the legislation as a <a href="http://www.theguardian.com/fashion/2015/apr/03/france-bans-skinny-models-crackdown-anorexia">“crackdown on anorexia”</a>, the laws may be unlikely to have any such effect.</p>
<h2>Not a lifestyle choice</h2>
<p>In western Europe, around <a href="http://bit.ly/1IhhGM7">0.5% of adults</a> are thought to be affected by anorexia nervosa. In <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892232/">around 10%</a> of these cases, the sufferers are men. These figures, however, are likely to be an underestimation. It has the <a href="http://www.b-eat.co.uk/about-beat/media-centre/information-and-statistics-about-eating-disorders">highest mortality rate of any psychiatric illness</a>, mostly due to organ failure and suicide. </p>
<p>Yet, the illness is often mistaken by many as a lifestyle choice with an external cause. Despite accounts of the disorder <a href="http://psycnet.apa.org/psycinfo/2005-00344-001">pre-dating</a> the fashion industry, the view that anorexia is caused by comparing oneself to a catwalk model remains popular. Likewise, while pro-ana websites insist that anorexia is <a href="https://theconversation.com/anorexia-advocates-turn-medical-condition-into-self-expression-23955%20clearly%20post-dates%20fashion%20industry">a commitment</a>, not an illness, they are <a href="http://s.telegraph.co.uk/graphics/projects/inside-the-world-of-anorexia-blogging/">highly exclusive</a> online communities, created by and for those already showing signs of the illness. The merely curious are not welcome. </p>
<p>Instead, the link between media endorsement of extreme thinness and the development of anorexia is neither simple nor clear. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11835293">Research</a> mentioned by Jackson did find that women evaluated their bodies more negatively after viewing images of thin models. However, this effect was small and mostly determined by women’s pre-existing opinions of their figures – women who were already dissatisfied with their body were most affected. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/78256/original/image-20150416-5657-88fu5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/78256/original/image-20150416-5657-88fu5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=514&fit=crop&dpr=1 600w, https://images.theconversation.com/files/78256/original/image-20150416-5657-88fu5s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=514&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/78256/original/image-20150416-5657-88fu5s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=514&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/78256/original/image-20150416-5657-88fu5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=646&fit=crop&dpr=1 754w, https://images.theconversation.com/files/78256/original/image-20150416-5657-88fu5s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=646&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/78256/original/image-20150416-5657-88fu5s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=646&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pre-existing opinions matter.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/narghee-la/3406513065/in/photolist-pXU97h-7JLjKy-aYGa7-jjehLk-4kRWu8-6c2gDT-dNZ1us-kfHC2K-7J82U4-dhcA7B-2xG4XJ-4kRWEp-bG13QP-4kRWxD-4BdK1F-iDRpV2-iDUqEq-iDUdAq-aCYM8m-4kRWBc-dTbsfW-7vuFro-dGPvVb-dPPEqJ-amuau6-xLzav-dmurhf-ckYRD9-ckYRH1-3aeqsW-2xG4VJ-2xG4X7-iDUtx9-iDUf8o-iDQiMp-iDUigs-iDQkvp-iDRhTg-iDRsa2-iDUpLb-iDUU6N-iDV2rQ-iDQWzx-iDQY9K-iDSwx9-iDQS5k-iDUXPQ-gjZYwb-5vdBa3-edPVwp">Joana Coccarelli</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>As this effect was only measured at one point in time, the effects of prolonged exposure are not known, but when more images were used there was a tendency for the effect to be smaller. Perhaps, as the authors suggested, these images activated, rather than cultivated, beauty ideals. </p>
<p>Whether the effects of media exposure on body dissatisfaction leads to changes in eating behaviour is also unclear. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1460-2466.1997.tb02692.x/abstract">Another study</a>, also cited by Jackson, looked for a link between a person’s real-life media exposure and eating disorder symptoms. The results were fairly inconsistent, with some factors – such as body dissatisfaction – only corresponding to some types of media, and others – such as self-worth – showing no relationship. </p>
<p>More importantly, the research showed correlation, not causation – it is just as plausible that women already unhappy with their bodies seek out thinness-promoting media more often. After all, if such a simple causal relationship did exist, the pervasiveness of these images in our culture raises the question of why the <a href="http://www.noo.org.uk/NOO_about_obesity/adult_obesity/UK_prevalence_and_trends">majority of our population is overweight</a>, rather than underweight.</p>
<h2>Model bans but no support</h2>
<p>Most researchers currently view the cultural value placed on thinness as a “background risk factor”. Meanwhile, several psychological and biological factors are implicated. </p>
<p>High levels of <a href="http://onlinelibrary.wiley.com/doi/10.1002/erv.850/abstract">perfectionism</a>, a need for organisation and a <a href="http://www.ncbi.nlm.nih.gov/pubmed/21554026">focus on details</a> are often observed in those with anorexia. <a href="http://bit.ly/1CLW8FT">Recent research</a> suggests there is a lower reward response to food in the brain, even after recovery. Some of these factors seem to be influenced by genetic inheritance. Stressful experiences may then influence whether these existing factors then lead to developing the disorder. More than one risk factor will be necessary.</p>
<p>So the legislation is likely to have little effect on the prevalence of anorexia in the general population, but it also offers no support to the models themselves. The law requires a medical certificate proving that a model has a BMI of at least 18. This <a href="http://apps.who.int/bmi/index.jsp?introPage=intro_3.html">is still underweight</a>, according to the World Health Organisation. Regular weigh-ins have been only vaguely suggested and there’s been no mention of an obligation to offer support to a model who fails a weigh-in. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/78252/original/image-20150416-5657-d1h5be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/78252/original/image-20150416-5657-d1h5be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/78252/original/image-20150416-5657-d1h5be.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/78252/original/image-20150416-5657-d1h5be.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/78252/original/image-20150416-5657-d1h5be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=545&fit=crop&dpr=1 754w, https://images.theconversation.com/files/78252/original/image-20150416-5657-d1h5be.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=545&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/78252/original/image-20150416-5657-d1h5be.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=545&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A BMI of at least 18 is still underweight.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/51528537@N08/8533690077/in/photolist-e16oKx-buoYGT-8jWa46-bup1Q8-74H2df-buoX4v-psG4Fn-psEjEG-psEseQ-pspWwk-pbcnww-psGaMR-pbcLSC-pbcvcG-pvdgvj-puXHRK-ghSoQ8-DdwLW-pveTAr-dhEc19-7Jg4JP-7J5cPL-bup2i4-7JjYZE-7J1hAk-qbRoiR-7Jg4Xc-rxrTLV-rxrTtv-rxrTVT-rfZTtx-rfTrV1-rxkUpB-rxkUsH-rxrTu2-rxmrCQ-qAsqyf-rxkUk8-qAEyoP-qAEy5H-rxmrGN-rfSvqY-rxkTLc-rfZTbt-rxmr17-rvaeHW-qAEy2X-rxkTX4-qAsqDA-rxkTP8">Fervent-adepte-de-la-mode</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>While <a href="http://www.sciencedirect.com/science/article/pii/S0165178107003666">there is</a> some <a href="http://www.sciencedirect.com/science/article/pii/S0165178112005057">debate</a> over whether models are at a higher risk of developing eating disorders, this career certainly encourages unhealthy behaviour. Thinness of this degree has hugely damaging effects on the internal organs, bones and brain. It can cause obsessiveness and social withdrawal even in <a href="http://psycnet.apa.org/psycinfo/1951-02195-000">psychologically healthy people</a>. France has <a href="http://www.bbc.co.uk/news/world-europe-12091475">already lost a high-profile model</a> to anorexia – yet the new laws almost encourage agencies to wash their hands of models who fall ill. </p>
<p>In the same way, while pro-ana content is undoubtedly harmful, the new laws punish those who are in need of help. This exclusively punitive approach is likely to drive these sites further undergound.</p>
<p>If the measures are enforced – if spot checks continue, weigh-ins aren’t cheated and other countries are supportive – they may be a positive move. They may be a first step towards a culture that prioritises health over aesthetics – whether that means a dangerously small or unhealthily large body. Nonetheless, this will mostly benefit the worried well – those who, regrettably, are unhappy with their bodies, but are otherwise unlikely to develop anorexia nervosa. Claiming that these laws address one of the most treatment-resistant mental illnesses is far too optimistic. </p>
<p><strong><em>This article was co-written by Lexie Thorpe, an MSc in Developmental Cognitive Neuroscience at Durham University</em></strong></p><img src="https://counter.theconversation.com/content/39954/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Cole-Fletcher does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Biological and psychological factors are implicated in anorexia. If it was just about media, why are many more people obese?Rachel Cole-Fletcher, Teaching Fellow, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/239552014-03-05T14:59:34Z2014-03-05T14:59:34ZAnorexia advocates turn medical condition into self-expression<figure><img src="https://images.theconversation.com/files/43184/original/375p4zyw-1394016373.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Valeria Lukyanova: a 'thinspiration' pin up.</span> <span class="attribution"><a class="source" href="http://www.youtube.com/watch?v=EIXyHTuL-TY">Youtube</a></span></figcaption></figure><p>Decoration and modification of the body have become a contemporary form of fashion. Aesthetic sensibilities once considered quite deviant (and now ordinary) commonly articulate our sense of self through adornments such as tattoos and body piercings. But would you consider anorexia to be a form of self-expression?</p>
<p>Among mainstream clinicians, both anorexia and bulimia nervosa are regarded as <a href="http://www.mentalhealth.org.uk/help-information/mental-health-a-z/E/eating-disorders/">a serious mental disturbance</a>, where symptomatic features include denial of illness and strong resistance to treatment. In contrast, anorexics can collectively normalise their condition, defending it as the achievement of self-control, a move towards success and perfection and an essential part of their identity. “Pro-ana”, the term used to promote the eating disorder and commonly referred to by anorexics simply as “ana”, is becoming more familiar. In some cases it is sometimes personified as a girl called Ana. </p>
<p>Pro-ana advocates differ widely in their stances about ana websites. Most claim they are principally a non-judgemental space for anorexics – but there are others who deny anorexia nervosa is a mental illness and claim rather that it is a lifestyle choice that should be respected as such by doctors and family. The less common term “pro-mia” refers similarly to bulimia and some users have again constructed a confidant modelled on Ana, this time named “Mia”. </p>
<p>Perhaps unsurprisingly, academic scrutiny has concentrated on the clinical features of anorexia – both physical and psychological. But there has been a growing interest in what it is like living with anorexia, there’s a paucity of research into the ana phenomena within social science, and almost none from the field of education. It is this that will unpick why some see it as a growing movement of resistance and rebellion, within broader themes of digital transgression and online communities. A paper <a href="http://www.tandfonline.com/doi/abs/10.1080/02673843.2013.856802#.UxcJk_l_tJM">we’ve just published</a> in the International Journal of Adolescence and Youth considers this very issue.</p>
<h2>Act of resistance</h2>
<p>It is possible to read pro-ana assertions as acts of resistance, not in any heroic way, but simply as young people marking out their sense of agency. Pro-ana advocacy has flourished on the internet, mainly through close, coherent, support groups centred on web forums and, more recently, social network services such as Tumblr and Facebook. These groups typically have an overwhelmingly female readership and claim they are frequently the only means of support available to socially isolated anorexics. </p>
<p>The real world of the Ana girls is both secretive and protective, yet this “closedness” becomes open and inclusive online. As CoLeYSkiN says in one post:</p>
<blockquote>
<p>No I don’t want my ‘parents noing wot I am doing, but you need to also get out to other ANA girls out there. They are your sisters. This is the point of ANA, that is the point of these sites … to tell others, to help others, to spread the WORD!</p>
</blockquote>
<p>Hunger-Hurts also refers to the idea of sisterhood:</p>
<blockquote>
<p>Really being Ana … being true, isn’t just about saying ‘I don’t eat, look how cool I am’ there are plenty of noobs who do that. But my site is about spreading the word, letting people know what we believe in and protecting what we want to do. We believe that thin is beautiful, and no one has the right to tell us otherwise. Who will protect my sisters if I am not here?</p>
</blockquote>
<p>Accounts like this are illustrative rather than exhaustive; they illuminate the choices these young people make. In particular these identities can be seen as a marker of passage from a dominant culture that is critical, often displaying horror and disgust, in favour of regaining authenticity through inverting what is “normal”.</p>
<p>Pro-ana sites act as an arena through which transgressive body narratives can be explored. “Thinspiration” (symbolic objects that encourage anorexic behaviours) is an important aspect. This usually takes the form of photographs, although on some websites it may also include poems, stories or pieces of music. Celebrity images are by far the most popular. At a mundane level, these (often posed) images function in much the same way that Jazzsimpleez uses Gok Wan to legitimise the anorexic form:</p>
<blockquote>
<p>You ever seen that ‘how to look good naked’ on TV? This fashion designer Gok Wan finds these really fat women and helps them get comfortable with their bodies. These are seriously fat women, that’s not healthy either, but no one mentions that, so when he does it it’s somehow ok. Well we’re just like Gok, but in reverse. We help people feel good about being thin, but we get crucified for it.</p>
</blockquote>
<p>It is important to note <a href="http://www.dailymail.co.uk/health/article-2398749/Pro-ana-Anorexia-blogs-nearly-killed-Starving-girl--17-says-thinspiration-sites-encouraged-her.html">that not everyone</a> who has become involved with Ana websites sees the experience so positively. There have been accusations that the virtual environment pushes young people further than they might go on their own. </p>
<h2>Subverting the clinical position</h2>
<p>Most sites also act as a resource in the creation of the Ana body and contain “tips and tricks” sections with important information for anorexics, including calorie content of foods, the rates that different forms of exercise burn food, reducing the health effects of binging. What is interesting here is that this often subverts the clinical position that has sought to define Ana as problematic through being ill-informed. </p>
<p>Far from being ignorant of health matters, pro-ana sites have amassed a wealth of clinical information that supports its activities: “People say being pro-ana means we don’t know anything about food. I know a lot about food – I just don’t want to eat it.” (Pear Girl)</p>
<p>And as Hunger Hurts says: “You don’t just get an ana body, it needs crafting. You have to know what you are doing.”</p>
<p>Importantly, these pro-ana environments are social spaces that provide ideal arenas in which adult norms and values are rejected and new expressions of order are established. In this way, a pro-ana subculture can be seen as a community that gives belonging, recognition of positive self-value, a sense of empowerment, a subculture that valorises resistance expressed through being transgressive. It promotes a culture in which the body itself, and its modification, becomes a medium through which marginal identities can be articulated. And in this way pro-ana advocates hope to transform a medical condition into something more akin to self-expression, freedom and control. </p>
<p>Bodies – whether virtual or material – are not neutral objects. As such they are important, and sometimes contested, sites of social and cultural meaning. Since the body shapes identity – in terms of how it is expressed through look, dress, actions – it also shapes the way that we form and participate within social relationships. </p>
<p>The clinical impact from anorexia is clear – it can cause irreparable damage or worse. But we also need to look at <a href="http://www.huffingtonpost.co.uk/zoe-thomson/pro-ana-websites_b_3706652.html">how young people are using this</a> to create and configure identities. And for education professionals and clinicians, it may be key to understanding how some young people feel about anorexia.</p><img src="https://counter.theconversation.com/content/23955/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Decoration and modification of the body have become a contemporary form of fashion. Aesthetic sensibilities once considered quite deviant (and now ordinary) commonly articulate our sense of self through…Nic Crowe, Course Leader in Contemporary Education, Brunel University LondonMike Watts, Professor of Education, Brunel University LondonLicensed as Creative Commons – attribution, no derivatives.