Log onto the internet and you’ll find hundreds of websites in many languages dedicated to eating disorder recovery. The problem? For every site focused on recovery, there are equally as many focused on “pro-ana” or “pro-mia” content, encouraging those with anorexia or bulimia to continue using eating disorder behaviors.

Pro-ana and pro-mia websites have existed since the inception of the web. In 2001, Yahoo removed 113 pro-ana sites from its servers for the health and safety of its users. With the invention of social media, however, pro-ana and pro-mia followers have found more and more places to congregate.

Type “anorexia” or “bulimia” into Tumblr or Pinterest and you will now find the National Eating Disorders Association hotline at the very top of the page. Yet pro-ana and pro-mia users are clever, finding ways to circumvent the rules by purposefully misspelling search terms (i.e. an0rex1a) until they are inevitably caught again.

The latest epicenter of pro-ana and pro-mia content? Tik-Tok. While Tik-Tok too has banned the search terms #anorexia and #bulimia, users who blog about eating disorder recovery say that watching just one video about eating disorders or weight loss can result in thousands of suggestions of pro-ana videos in its “For You” section.

In this blog post, we explore the brief, yet dangerous history of pro-ana and pro-mia content online, as well as its implications for patients with eating disorders.

The History of Pro-Anorexia

Eating disorders date back over five centuries. During the rule of the Catholic Church in Europe, women who performed extreme fasting were praised for being “holy.” Until the 16th century, these women and their behaviors were widely accepted.

Anorexia, as it is understood today, became a cultural fixture in the 20th century. During the 1960s and onward, the body type considered most attractive by the mainstream media shifted to become skinnier and less curvaceous, with the advent of models like Twiggy and, later, Kate Moss.

Nowadays, the stigmatization of fatness in American society is said to breed anorexia. We’ve experienced a surge in the rates of eating disorders — and along with it, a surge in members of the pro-ana subculture.

People with anorexia have long banded together as a subculture. While society treats their behavior as “disordered,” those in the pro-ana subculture claim that they are rebelling and exercising their willpower by refusing to eat. Thus, they band together, surrounding themselves with others who accept their behavior.

However, it wasn’t until the arrival of the internet that pro-ana communities came out into the open. While the internet has allowed many people in recovery to support one another, it has also allowed groups of people with anorexia, who consciously choose this disorder as a lifestyle, to compete with one another and encourage one another in their quest to lose weight.

Problematically, pro-ana groups resist recovery. While society sees that anorexia is slowly killing these people, pro-ana groups shame those who recover as “getting fat” and giving into society’s demands of eating. This makes pro-ana groups extremely dangerous for those suffering from anorexia, as well as those who have not yet developed an eating disorder, who may become triggered after seeing enough of this content over time.

The Pro-Ana Message

Pro-ana sites are not meant for those who do not have eating disorders or who are in recovery from an eating disorder. They are meant for people who believe anorexia is a lifestyle choice and is the only way to achieve happiness and perfection.

The problem with this message is that it is inherently disordered. Believing that starvation is the only road to happiness leads those with anorexia nervosa to relentlessly pursue weight loss, yet achieving their “goal weight” is never enough. As a rule, those with anorexia are never satisfied no matter how much weight they lose.

Yet members of the pro-anorexia community believe that they do not have a disease and therefore will not die. They believe they are fully in control of their behavior and use this to separate themselves from other people with anorexia.

Still, this is clearly a false delusion, as many owners of pro-anorexia sites abandon them to go into recovery or to “take it easy” for a while. While members of the pro-ana community believe that they have mastered their bodies, anorexia continues to affect their physical health as it does for anyone else with an eating disorder.

The Risks of Pro-Ana Content on Social Media

Visual social media platforms like Tumblr, Instagram, Pinterest and Tik Tok have become watering holes for the pro-anorexia movement. The visual nature of their content allows “thinspiration” or “thinspo” to run rampant: photos of extraordinarily skinny women, quotes such as “skip dinner, wake up thinner” and weight loss progress reports.

Many sites, including Tumblr and Pinterest (which have had some of the most fervent pro-ana communities), have since blocked pro-anorexia terms from the search results. Instead, they display a self-help message guiding users to eating disorder resources and hotlines. But the pro-ana communities have since found ways to circumvent these bans by deliberately misspelling search terms to help them evade filtering by social media platforms.

One of the dangers of pro-ana content on social media is the fact that all people can become exposed to it. A search for “diet” or “fitness” can quickly turn into a spiral down a rabbit hole of thinspiration and pro-ana content. And given that teenagers spend up to nine hours per day on social media, that is a lot of potential for exposure to dangerous pro-anorexia content on social media.

Users of social media who have other mental health conditions may be especially at risk. For example, young sufferers of depression may find their way to pro-ana content through the #depression hashtag and become “enchanted by it,” as Laura Cerrator writes for the Center for Digital Ethics and Policy. As someone with depression, they may be at increased risk of developing an eating disorder by viewing pro-anorexia content.

However, there is evidence that anyone who is exposed to pro-ED content of any kind can be negatively impacted by its influence. A study of college-aged women found that viewing pro-ED content resulted in lower self-esteem and perception of oneself as heavier. Even if viewing pro-ana content on social media does not directly lead to an eating disorder, it can still have an important effect on a person’s self-perception and self-esteem.

Yet while the risks of pro-ana content should not be ignored, there is still plenty of content on social media that promotes weight loss, albeit in a more subtle way, that has yet to be banned by social media platforms. From apps like My Fitness Pal and Sparkpeople to magazines like Self and Women’s Health, even the promotion of weight loss in a “healthy” way has the potential to harm a person’s body image and lead to the development of an eating disorder.

Obviously, harmful weight loss and body image content exists on a continuum, where pro-ana content represents some of the worst of the worst. Still, that does not mean that other content promoting weight loss is not harmful when it is pushed out via social media. While the pro-ana subculture is especially dangerous for young, impressionable women, the more widely accepted weight loss and “fitness” content pushed out by the mainstream media is also harmful when young people are exposed to it in increasing degrees.

What to Do About Pro-Ana Content

Experts disagree on how the issue of pro-anorexia content on social media should be handled. Should it be criminalized and the women behind the accounts held responsible for the deaths of those whose eating disorders worsened due to pro-ana content? Or should it be handled differently? Boston Legal even featured pro-ana as its case of the week, debating this very issue.

Some countries believe the issue should be handled by the courts. In June 2014, legislators in Italy’s Parliament proposed a bill that would fine the creators of pro-ana sites and subject them to up to a year of jail. However, some researchers say this move could be even more dangerous, pushing pro-ana sites even further underground where they cannot be discovered. Furthermore, criminalizing the owners of pro-ana sites prevents them from receiving the help they need to recover from this mental illness.

Other researchers believe that some pro-ana sites have some benefits to people with eating disorders by offering social support, which often becomes minimal as individuals progress along the eating disorder path. While in-person support groups require a person to be ready for recovery, pro-ana sites are often anonymous and allow people to speak with others in the community no matter where they are in their recovery journey. And while dangerous, extremist pro-ana websites do exist, thankfully, a meta-analysis found that these sites are the exception, rather than the rule.

Researchers have yet to come to a consensus on what should be done about pro-ana websites. While some pro-ana websites promote dangerous “thinspiration,” others provide support to people who feel alone in the midst of their disorder — often those who have not been formally diagnosed because doctors deemed them “too heavy” or “too old” to have an eating disorder.

Conclusion

Pro-ana and pro-mia content represents a dangerous subculture that still runs rampant on the web, despite attempts to curtail it by banning keywords and offering self-help messaging when individuals search for this content. Experts disagree on what should be done about pro-ana content, but what remains blatantly obvious is that extreme pro-ana content is harmful to individuals with and without eating disorders alike. However, while pro-ana content has generated much attention, little attention has been drawn to the harm of mainstream content that promotes weight loss and fitness in more subtle ways.

If you or someone you love has been impacted by viewing pro-ana content, help is available. Our trained counselors are happy to guide you through talking about your experiences and provide non-judgmental support