Mixed Messages

The pro-eating-disorder sites feed into anorexics' competitive nature, says eating-disorder specialist Dr. David S. Rosen, a professor of pediatrics and internal medicine at the University of Michigan. "They're constantly trying to be the sickest, the thinnest, the most unhealthy. If you go to a Web site where people are describing their eating habits, their vomiting practices, if you're in the throes of a serious eating disorder, no matter how that information was intended when it was put out there, it may be a challenge to eat less, to take more diet pills, to weight less. That's where the harm is."

Even if the sites featured more bad news about the disease, Rosen isn't so sure the women would care. "I have lots and lots of patients for whom, even though we talk about serious medical consequences and death, it's not a compelling reason for them to want to change," he says. One stereotypical phrase in the profession: "At least I'll be thin in my coffin." "When the brain has been starved as long as it has been, it doesn't work right any more," says Rosen.

Anorexics are similar to obsessive compulsives, says Rosen. The Internet helps them "indulge that obsessive quality," he says. One college patient has a 60-page scrapbook of thinspirational pictures, poetry and information from Web sites. "Fewer than five" of his patients have had a "meaningful recovery aided by a Web site" whereas "a whole lot more than five" have been "substantively worsened" by them, he says. They may be especially harmful for the growing number of younger children with eating disorders. "They're more impressionable, they're less able to think critically about what they're reading and seeing on these Web sites," he says.

Doctors aren't sure whether the pro-ana and pro-mia sites may trigger eating disorders. "A Web site could take somebody who is flirting with an eating disorder and disordered eating behavior and drive their behavior up to where they develop the thinking," says Rosen. It's like a teen who tries cigarettes. "Nobody thinks they're going to become addicted to tobacco," he says. "All of the sudden, they find they can't stop." Anorexics may start out with simple dieting, which then becomes more extreme and obsessive. "For some people, these Web sites may be one of the forces that drives their behavior further over the line because there is that sense of community, that normalization of behavior," he says.

Could the sites somehow lure a completely healthy girl into becoming an anorexic? "You've still got to have some sort of predisposition," says John Levitt, director of the eating-disorders program at Alexian Brothers Behavioral Health Hospital in Hoffman Estates, Ill. "It's a little bit difficult to believe they went there and were pure." Most patients "don't need the advice," he says. By the time he sees them, they already know the tips and tricks. But, he says, "if you have a predisposition for something, you get reinforcement for it."

In November, the Academy for Eating Disorders issued a warning about the proliferation of sites promoting anorexia and asked government officials and Internet service providers to require warning screens for them. AED president Eric van Furth suggested a statement like "Warning: anorexia nervosa is a potentially deadly illness. The site you are about to enter provides material that may be detrimental to your health." Parents, take note.

© 2006