Out of the Shadows

A Web page labeled "Ana Boot Camp" recently offered its members a seemingly irresistible proposition: a 30-day regimen designed to help them drop some serious pounds, no exercise needed. The catch was that the group's members were to vary their daily caloric intake from 500 (less than half the daily minimum requirement for women recommended by the American College of Sports Medicine) to zero. They were supposed to track their progress, fast to make up for the days they accidentally "overate" and support each other as they worked toward their common goal of radical weight loss.

Pro-anorexia, or "pro-ana," Web sites (with more than one using the "Ana Boot Camp" name) have for years been a controversial Internet fixture, with users sharing extreme diet tips and posting pictures of emaciated girls under headlines such as "thinspiration." But what was unusual about the site mentioned above (which is no longer available) was where it was hosted: the ubiquitous social networking site Facebook.com. The (largely female) users who frequent pro-ana sites have typically done so anonymously, posting under pseudonyms and using pictures of fashion models to represent themselves. Now, as the groups increasingly launch pages on Facebook, linking users' real-life profiles to their eating disorders, the heated conversation around anorexia has become more public. Many pro-ana Facebookers say the groups provide an invaluable support system to help them cope with their disease, but psychologists worry that the growth of such groups could encourage eating disorders in others.

Rose, 17, a Maryland high-school senior who, like several other women interviewed for this story, asked to be identified only by her first name, was active in pro-ana Facebook groups for two years. There, she found a community of people like her—people who had a disease with which few of their friends could identify. "These sites provided a setting where I could talk about the illness without people trying to fix me or tell me that what I'm doing is horrible, disgusting, maladaptive," she says. "For me, part of the illness was just about getting attention. You feel so lonely and you want someone to notice you, and I guess that's kind of the way to do it, even with other sick people."

Many members of the Facebook groups have migrated over from other social networking sites, like MySpace and Xanga. "Facebook's the most personable," Rose says. "If you're on something like MySpace, that's famous for creepy old men. Facebook seems the safest." Kate, a 20-year-old Utah college student, says being able to see people's faces, friends and interests on their Facebook sites makes for a more intimate community. "It's a lot more of a support group for pro-ana," she says. "MySpace was more focused on tips and tricks and when to exercise. [On Facebook], there's a lot of really close networking, so you add those people as friends and exchange phone numbers, and when you're having a hard day, you talk on the phone."

Dr. Steven Crawford, associate director of the Center for Eating Disorders at Sheppard Pratt in Baltimore, sees the openness of the Facebook site as part of its appeal. Increasing numbers of teenage patients at the center are joining Facebook groups that proclaim their disorders to the world, which Crawford believes is a means of adolescent rebellion: "It's almost like putting it in your face: I have an eating disorder. I am anorexic."

Pro-ana group creators insist that they aren't recruiting anorexics and are just supporting each other. In fact, there are some groups that are legitimately focused on recovery. Still, the effects of even such makeshift support groups are likely not as benign as some fans claim. "The more types of these sites that you use, the higher your risk for disordered eating is," says Stanford professor Rebecka Peebles, M.D., acknowledging that that correlation doesn't prove that the sites necessarily contribute to the disorder. A 2006 study that she coauthored found that 96 percent of teens diagnosed with eating disorders who visited pro-eating disorder Web sites learned new dieting and purging techniques, and almost 50 percent of teens who visited sites ostensibly devoted to eating disorder recovery also learned new weight-loss tips.

The openness of Facebook isn't universally appealing—some girls still create fake profiles with names like Skinny Minny and Ana Thin or worry that their friends will notice the groups they've joined—but many users fit the defiant profile Crawford describes. Stef, 19, says her friends have asked why she's joined so many pro-ana groups, but she doesn't care if they're worried; having access to thinspiration, weight-loss tips and fasting partners is more important. "I basically say it's helping me deal with my eating disorder, either for good or for bad, but I know that I'm taking care of it in the best way possible," the Pennsylvania college student says.