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Online eating disorders

Anorexia and bulimia find a home on the Web - one that's 'dangerous and disturbing'

BY JANUARY W. PAYNE | THE WASHINGTON POST

September 21, 2004

Alison Devenny, 19, of New Jersey, visited pro-eating disorder Web sites regularly until seeking treatment recently. (Washington Post Photo/Andrea Bruce Woodall / September 21, 2004)

WASHINGTON - For three years, when Alison Devenny wanted weight- loss tips, she turned to the Internet. But she didn't look for typical dieting Web sites. The George Washington University sophomore visited Web sites that encourage visitors to embrace anorexia and bulimia as "lifestyle choices" and provide instruction on how to do so.

The sites provide "thinspirational" pictures of extremely underweight women, menu suggestions, discussion boards and tips on topics including ways to overcome hunger pangs, such as doing household chores and drinking lemon water.

Despite attempts to encourage Internet service providers to close down such sites, many continue to exist. A recent Google search using the term "pro-anorexia" yielded 30,000-plus results. Many were links to pages by health authorities warning about the pro-anorexia movement, while others were links to sites no longer in operation. But many linked to live sites. A Google directory called "Pro-Anorexia" links to more than 50 sites.

Carol Day, director of health education services at Georgetown University and a member of the school's eating disorder treatment team, called the sites "dangerous and disturbing." Experts say the sites can reinforce unhealthy behaviors, slow the recovery process and discourage people from seeking help.

"I think anyone who is working in the field of eating disorders realizes how unhealthy" the sites are, Day said.

"I always kind of knew that what I was doing was stupid," said Devenny, now 19, who has since begun treatment for multiple eating disorders. She used to visit the sites about twice a week, she said, picking up tips on how to avoid eating and how to keep her illness a secret.

"Ana" and "Mia"

The terms "Ana" and "Mia" - short for anorexia (a condition characterized by eating so little that one's health and life are at risk) and bulimia (overeating and then purging by vomiting or taking laxatives) - are often used by those with eating disorders who don't want treatment.

Frequent visitors to these sites refer to themselves as "Anas" and "Mias" and say the sites offer a safe haven where they can talk, share advice and commiserate away from the criticism of family, friends and other "outsiders." The sites' creators are typically teenagers and young adults who have eating disorders. Many are directed at women, who experience eating disorders more often than men.

About 0.5 to 3.7 percent of women suffer from anorexia in their lifetimes, according to the National Institute of Mental Health. About 1 to 4 percent are bulimic. It estimates that 2 to 5 percent of Americans experience binge eating disorder (characterized by excessive eating that occurs, on average, at least two days a week in a six-month period).

Eating illnesses

Those with eating disorders exhibit serious disturbances in eating behavior and feelings of extreme concern about body shape or weight, the institute says. Researchers are investigating how voluntary behaviors, such as eating different sizes of food portions, at some point develop into an eating disorder. Experts agree that eating disorders are not due to a failure of will but are treatable medical illnesses.

Eating disorders often are accompanied by depression, substance abuse and anxiety disorders. Common personality characteristics include excessive anxiety, perfectionism and low self-esteem.

Treatments include hospitalization or outpatient treatment, as well as psychotherapy, nutritional counseling, cognitive therapy, behavioral therapy and antidepressant medication, according to the Harvard Eating Disorders Center.

About half of people with anorexia or bulimia recover through treatment, according to the Harvard center. About 30 percent make a partial recovery, and 20 percent have no substantial improvement. The mortality rate for anorexia is about 5.6 percent per decade, according to the institute. Cardiac arrest and suicide are common causes of death for anorexics.

But "Anas" and "Mias" say they are not sick, don't need to be "fixed" and don't want sympathy. They develop creeds and post poetry and online diaries reciting their beliefs. They applaud one another for reaching low weights. Their message board conversations often turn to statistics: height, weight, measurements.

A site called Blue Dragon Fly sells red bracelets to encourage "solidarity" among pro-Anas. "So you can go out into the world and not have to wonder, 'Is she or isn't she?' . . . You see the red bracelet, and you know," the site explains.

Sites offer eating tips

But it's the pro-eating disorder advice that many women say they seek. There are tips for the best foods to eat and vomit up later ("remember if it is hard to swallow, it will be hard to 'unswallow,' " one site says) and covering up your eating disorder (tell friends and family you're sick or have already eaten, tips another site advises). A college sophomore from Alexandria, Va., diagnosed with bulimia and anorexia, said tips from pro-eating disorder sites helped her go from 161 pounds to her current 74 pounds.

"At times I did gain back the weight, but I would always make a plea for help on the pro-Ana" Web sites, she wrote in an e-mail responding to a reporter's question. She asked not to be identified by name, adding that although her family knows she has an eating disorder, they don't know - and wouldn't approve of - her visiting these sites. She called the sites "a tether to bring me back on track when I start to think about going into rehab or bingeing without purging."