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I Will Not Eat! A Review of  the Online Pro-Ana Movement

Hadley A. Johnson
Derner Institute of  Advanced Psychological Studies

Adelphi University

Eating disorders are a persistent concern in the psychiatric community given their often elusive causes and high 
mortality rates (Crow et al., 2009; Polivy & Herman, 2002); In a longitudinal assessment (years 1979-1997) by 
Crow et al. (2009), mortality rates were 4.0% for anorexia nervosa and 3.9% for bulimia nervosa. Pro-eating dis-
order websites have been studied in recent years for their impact on body image and eating disorder pathology 
among viewers. This paper is a review of  current literature about pro-eating disorder websites, which provide 
nutritional information, images of  thinspiration (a portmanteau of  the words thin and inspiration), and message 
boards for social interaction, all with the goal of  promoting eating disorders. The content and emerging themes 
of  pro-eating disorder websites are discussed in this paper order to understand the context of  the interaction 
between website and viewer. Next, the social interaction that takes place on these sites is examined in order to 
understand the nature of  social support and social exclusion existing on these sites. Finally, studies that have in-
vestigated the effects of  pro-eating disorder viewership on affect, body image, and eating behavior are discussed. 

Introduction

 Pro-eating disorder websites host communi-
ties of  individuals who engage in disordered eat-
ing and use the internet to discuss their activities 
(Wilson, Peebles, Hardy, & Litt, 2006). Csipke and 
Horne (2007) conceptualize two definitions of  the 
term pro-eating disorder in the context of  internet 
communities. The first defines the term as a will-
ingness to accept that an individual has an eating 
disorder without seeking to encourage that indi-
vidual to find treatment, and may imply an aim to 
motivate or enable continuation of  disordered eat-
ing behavior. The second definition characterizes 
the term as the understanding of  eating disorders 
as lifestyles rather than disorders. Both conceptions 
of  the term will be examined throughout this paper.
 Eating disorders are a pressing concern in the 
mental health community. In a sample of  10,123 ad-
olescents it was found that 0.3% suffered from an-
orexia nervosa (AN) and 0.9% suffered from bulimia 
nervosa (BN; (Swanson, Crow, Le Grange, Swend-
sen, & Merikangas, 2011). According to Crow et al. 
(2009), mortality rates were 4.0% for anorexia ner-
vosa, 3.9% for bulimia nervosa (data was collected 
between 1979 and 1997 at an eating disorder clinic 
with assistance from the National Death Index). In 
addition to their high mortality rates, eating disorders 
are difficult to treat and represent a biopsychoso-

cial illness whose causes are often elusive (Polivy & 
Herman, 2002). According to the current Diagnos-
tic and Statistical Manual of  Mental Disorders (5th 
ed.,; DSM–V; American Psychiatric Association, 
2013), AN is characterized by a refusal to maintain 
a weight that is 85% or more of  what is expected, 
disturbance in the way one’s body weight or shape 
is experienced, undue influence of  body weight or 
shape on self-evaluation or denial of  the serious-
ness of  the current low body weight, and amenor-
rhea. There are two distinct types of  AN: restricting 
type and purging type. Restricting-type patients are 
characterized by their insistence on eating very little, 
whereas purging-type patients regularly engage in 
binge eating and purging. It is important to note that 
AN purging type is distinct from BN, though vomit-
ing and the use of  laxatives are common to both; the 
distinction lies in the context in which purging takes 
place—whether it is during an episode or anorex-
ia or bulimia (Anorexia and Bulimia Nervosa, n.d).
 The Diagnostic and Statistical Manual of  Mental Dis-
orders (5th ed., DSM–5; American Psychiatric Asso-
ciation, 2013), defines the diagnostic criteria for BN 
as regularly eating more food in a given period of  
time than a person normally would and a concurrent 
loss of  control over eating. In addition, compensato-
ry efforts such as purging or fasting are employed to 
counteract the effects of  binge eating and self-evalu-
ation is overly dependent on body weight and shape. 
The binge eating and inappropriate compensato-
ry behavior both occur, on average, at least twice a 
week for three months. BN has two distinct subtypes: 
purging and non-purging type. Purging type patients 

Correspondence concerning this article should be ad-
dressed to: Hadley A. Johnson, 158 Cambridge Ave., 
Hy Weinberg Building, Room 302; Garden City, NY 
11530. Email address: hadleyjohnson@mail.adelphi.edu.



71

regularly engage in self-induced vomiting or the 
misuse of  laxative, diuretics, or enemas. Non-purg-
ing type patients fast or over-exercise to compen-
sate for binge eating, but they do not engage in the 
same compensatory efforts as purging type patients. 
 Binge Eating Disorder (BED) is similar to BN 
in that binge eating is at the core of  the disorder; 
however, individuals with BED make no inappro-
priate compensatory efforts to counteract the high 
caloric intake. As a result, this disorder is sometimes 
associated with obesity. Because the focus of  this 
paper will be on websites that promote weight loss 
through inappropriate or unhealthy means, BED will 
not be discussed in relation to online communities. 
 The lifetime prevalence rates of  AN and BN 
are 0.3% and 0.9%, respectively (Swanson, 2011). 
Among adolescents the 12-month prevalence rates 
are 0.2% for AN and 0.6% for BN and the medi-
an ages of  onset are 12.3 and 12.4 years, respectively 
(Swanson et al., 2011). Eating disorders stem from 
myriad causes and it is impossible to identify one 
event or condition that leads an individual to de-
velop an eating disorder. Influences that may shape 
the development of  an eating disorder include so-
ciocultural factors (e.g., media and peer influences; 
Nasser, 2010; Paxton, Schutz, Wertheim, & Muir, 
1999), body dissatisfaction and concern about weight 
(Killen et al., 1996), and cognitive and biological fac-
tors (Fairburn, 2001). This paper will examine the 
role of  community within the context of  pro-an-
orexia (pro-ana) and pro-bulimia (pro-mia) websites 
in the reinforcement of  disordered eating habits. 
 Pro-eating disorder websites are available to 
anyone with internet access and are often host-
ed by large and well-known domains. A study of  
711 children and adolescents in 7th, 9th, and 11th 
grade found that 12.6% (n = 90) of  the girls and 
5.9% (n = 42) of  the boys had visited pro-anorexia 
websites (Custers & Van den Bulck, 2009). A sepa-
rate survey of  76 patients who had been treated for 
eating disorders in an outpatient clinic showed that 
35.5% had visited pro-eating disorder sites (Wil-
son et al., 2006). Csipke and Horne (2007) found 
that among a group of  151 individuals with eating 
disorders, 54 (36%) initially found the websites via 
the internet or search engines as opposed to find-

ing them through the media or by word of  mouth. 
 There is evidence that searching for pro-eating 
disorder content is a popular phenomenon, with 
over 100,000 monthly searches on Google.com for 
each of  the search terms “pro-ana,” “thinspo,” and 
“thinspiration” (Lewis & Arbuthnott, 2012). In-
terestingly, the term “pro mia” is less frequently 
searched, with less than 100,000 searches per month. 
Though the reasons for this are unclear, it is possi-
ble that the “ana” identity is viewed as more desir-
able than the “mia” identity. One limitation of  this 
study is that it measured the frequency of  searches, 
which does not account for a single user search-
ing multiple times for pro-ana terms. Since several 
searches likely reflect the same individuals conduct-
ing multiple searches, the number of  people search-
ing for pro-eating disorder content is unknown. 

Website Content
 In order to understand how pro-eating disorder 
websites influence an individual’s eating behavior and 
self-concept, it is first necessary to examine what these 
websites offer. Pro-eating disorder websites offer con-
tent that ranges from images to information on weight 
loss to interactive features. Each of  these types of  
content will be examined in this section of  the paper. 

Images 
 Pro-eating disorder websites offer a variety of  
content on the topic of  weight loss. One notable 
type of  content is the use of  images. The occurrence 
of  eating disorders has been linked to a thin ideal 
body type associated with Western culture (Nasser, 
2010). Eating disorders have been found to be more 
prevalent in Western than in non-Western countries 
(prevalence rates ranged from 0.3% to 7.3% in female 
subjects in Western countries compared to 0.46% to 
3.2% in female subjects from non-Western countries) 
while disordered attitudes about eating appear to be 
increasing in non-Western countries (Makino, Tsuboi, 
& Dennerstein, 2004). Social class (as characterized 
by education and wealth) has also been implicated in 
the rising prevalence of  anorexia nervosa (Darmon, 
2009), possibly because thinness and frailty are equat-
ed with high social status and differentiation from 
lower classes (Brumberg, 1988). In a culture where 

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72

nutrition and wealth are abundant, the slim body type 
becomes idealized and is over-represented in the me-
dia. However, exposure to the media is so widespread 
that Polivy and Herman (2002) argue that if  such ex-
posure were the sole cause of  eating disorders, then 
it would be difficult to explain why anyone in cultures 
that are not deprived would not be eating-disordered. 
While it is undeniable that images of  thin models and 
actresses portray unrealistic representations of  the 
human body, they cannot be sole factors in contrib-
uting to the number of  eating disordered individuals. 
 Thinspiration consists of  words and images in-
tended to promote weight loss. According to Lap-
inski (2006), thinspiration can be conceptualized to 
comprise three categories: triggers, reverse triggers, 
and distractors. Triggers are designed with the inten-
tion of  motivating or reinforcing eating disordered 
behaviors; triggering content may include models, 
actresses, or women suffering from eating disorders 
who have achieved a very thin body type. In a sys-
tematic study of  content on 180 active pro-eating 
disorder websites, it was found that 85% contained 
thinspiration material. Known fashion models were 
most frequently shown (66% of  sites included at least 
one photograph of  a model), followed by celebrities 
(57%), non-celebrities (44%), and athletes (12%; 
Borzekowski, Schenk, Wilson, & Peebles, 2010). 
 When “real” women post pictures of  themselves 
(particularly “before” and “after” images) they are 
simultaneously seeking recognition for their weight-
loss achievement while serving as inspiration for 
other women. “Real” is the descriptor given to these 
women, who may also be referred to as “normal” on 
the websites in order to distinguish them from mod-
els, dancers, or celebrities (Borzekowski et al., 2010). 
In the “before” pictures, women are typically either 
normal or overweight and the “after” pictures show 
dramatic weight loss. There are several desirable 
markers that indicate the idealized level of  weight 
loss, including visible collarbones, hipbones, and a 
“thigh gap.” A sub-type of  thinspiration, or “bones-
piration” (abbreviated as “bonespo”), has emerged 
to promote the desirability of  a skeletal appearance. 
“Bone pics” are pictures of  emaciated women and 
digitally manipulated pictures of  models to make 
them look skeletal (Bardone-Cone & Cass, 2007). 

 In contrast to triggering images that celebrate a 
thin figure, images of  overweight women are often 
presented as thinspiration content in order to serve 
as a reverse trigger. Thus thinspiration not only pro-
motes the idealized thin body type, but also publi-
cizes the feared heavy body type that readers try to 
avoid (Dalley & Buunk, 2009). In a study involving 
134 female participants, it was found that frequent 
dieting is primarily motivated by a desire to avoid an 
overweight identity, rather than by a desire to acquire 
the favorable thin identity (Dalley, Buunk, & Umit, 
2009). Though frequent dieting may be considered 
clinically distinct from AN, this is a significant find-
ing that may lead to a new way of  conceiving of  ex-
treme weight loss since it appears to represent a flight 
from the unfavorable as opposed to a race toward 
the favorable. While the desire to avoid an overweight 
identity may be powerful, reverse triggers appear to 
be in the minority of  thinspiration content. Lastly, 
distractors offer methods of  reducing or ignoring 
the hunger impulse. Distraction content includes pic-
tures of  “food porn,” or images of  decadent food 
shown to induce satiation. Another common dis-
tractor is content urging an individual to exercise 
or drink water to reduce hunger (Lapinski, 2006). 

Tips and Tricks 
 “Tips and tricks” are strategies intended to pro-
mote weight loss. In a survey of  20 pro-eating disor-
der websites, Norris et al. (2006) found that 67% of  
these websites contained “tips and tricks” material. 
Wilson et al. (2006) found that among 76 individ-
uals diagnosed with an eating disorder who visited 
pro-eating disorder websites, 96% reported learn-
ing new weight loss or purging techniques from 
these sites. Tricks typically included methods of  
hiding weight loss and techniques for creative calo-
rie avoidance. For example, so-called “negative cal-
orie” foods, which are believed to require more en-
ergy to digest than is supplied by the nutrition, are 
often promoted as a way of  satiating hunger while 
burning calories. It appears that pseudoscience and 
“guesswork nutrition” are mixed indiscriminate-
ly with true nutritional facts (Martin, 2005, p. 157).
 According to a content study of  pro-eating dis-
order websites, more than 70% (n = 126) offered 

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73

dieting strategies, including specific dietary regimens 
and advice on fasting; 68% (n = 122) listed “safe” 
foods or charts with low-calorie food; 50% (n = 90) 
offered tips on purging or the use of  laxatives or 
diet pills; and 43% (n = 77) offered advice on how 
to hide an eating disorder from others (Borzekows-
ki et al., 2010). The study identified certain portions 
of  text that characterize the extremes of  severity and 
intricacy of  these tips. On the seemingly harmless 
end of  the spectrum is an example such as: “Sit up 
straight. You’ll burn at least ten percent more calo-
ries sitting upright than reclining.” On the severe 
end is: “TO PURGE: You can start off  with two 
fingers or a Toothbrush — 3 fingers if  nothing is 
happening. Next, rub the back of  your throat; you 
should feel sort of  a Buttonish thing at the back. 
Well, you need to push it!” (Borzekowski, 2010).
 While “tips and tricks” are principally associated 
with advice of  how to lose weight, pro-eating disor-
der websites frequently offer other tips on how to 
conceal weight loss from concerned family, friends, 
or medical professionals. Findings of  a content anal-
ysis of  pro-eating disorder websites that illustrate this 
phenomenon include: “Wear nail polish to hide the 
discolouring [sic] in your nails for lack of  nutrients” 
and “Do anything you can to make yourself  weigh 
more [before a doctor’s visit]” (Harshbarger, Ahlers-
Schmidt, Mayans, Mayans, & Hawkins, 2009).   

Website Features
 Interactive features have been found on 79% 
(n = 142) of  pro-eating disorder websites (Borze-
kowski et al., 2010). Interactive tools vary by web-
site and might include discussion boards, message 
boards, personalized diet or exercise-related tools, 
or ways of  posting comments or artwork. Tumblr 
allows users to “reblog” another user’s comment or 
photo, thus propagating the original post and expo-
nentially increasing its influence. Interactive features 
enable users to share their progress as measured by 
weight loss, measurements, or days fasting, and to 
engage in member-against-member competition 
(McCabe, 2009). Interactive features aid in sustaining 
communities that function similarly to cliques, which 
are characterized by shared interests, exclusion, and 
competition within the group, and have been shown 

to have a negative impact on body image and disor-
dered eating (Paxton et al., 1999; Wilson et al., 2006). 
 Another feature of  many pro-eating disorder 
websites are disclaimers. Norris et al. (2006) ob-
served that warnings and/or disclaimers before en-
try into the web pages were posted on 58% (n = 7) 
of  the websites. These disclaimers included asking 
non-eating disordered persons to leave the website, 
acknowledging that the website supported the pro-
ana movement and prohibiting persons under the 
age of  18 to enter without parental consent. This 
prohibition is not enforceable, however, and teen-
agers are able to access the sites. For their study on 
the examination of  pro-anorexia website exposure 
and moderating effects among female undergradu-
ates, Bardone-Cone and Cass (2007) created a pro-
totypical disclaimer based on an extensive search of  
pro-eating disorder websites. The disclaimer read: 

This is a pro-Ana site. If  you are recovering from 
an eating disorder or hate the fact that pro-Anas 
exist, I suggest you leave! Now!!! This site is for 
those who feel that Anorexia is a life-style, and 
that we should have a choice to leave Ana or take 
comfort in that which defines us. WARNING!!! 
SOME MATERIAL MAY BE TRIGGERING.

Some disclaimers are written within the context 
of  anorexia as a medical illness, as opposed to a 
lifestyle. The moderator of  one website posted:

If  you’ve come here to “learn” to be anorexic 
or bulimic, then you really need to leave. Eat-
ing disorders are painful, life-destroying crea-
tures that are not worth their cost. They are 
not cool or glamorous. They are not a quick fix. 
They are not a diet. They are a living, breath-
ing hell. But once you’re in, you’re in. You’re in 
until it either kills you or destroys your life so 
much that you have to break free. So stay out. 
Stay back. Stay sane (Strife & Rickard, 2011).

Emerging Themes

Eating Disorders as a Lifestyle Choice
 Many themes have emerged as common among 
pro-ana disorder websites. A central theme appears 
to be the concept of  eating disordered behavior as a 

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74

lifestyle rather than an illness that requires treatment. 
While the theme of  lifestyle choice seems apparent 
to visitors who are not pro-ana, only 20% of  pro-eat-
ing disorder sites explicitly state the opinion that pro-
anas view eating disorders as a lifestyle choice (Borze-
kowski et al., 2010). The discrepancy between public 
perception and stated intention of  site moderators in 
the portrayal of  eating disorders as a lifestyle choice 
may lie in the definition of  the phrase, “lifestyle.” 
 Csipke and Horne (2007) described two per-
ceptions of  the word “lifestyle” in this context. The 
first understanding of  the word describes a lifestyle 
as a chosen manner of  living one’s life and entails 
embracing a set of  values that characterize the life-
style—perhaps even promoting them. According 
to the second perception, an eating disorder is not 
adopted by choice. Rather, it is a lifestyle in the 
sense of  “a way of  life” that pervades every aspect 
of  the person’s thoughts, perception and action. 
 While the promotion of  eating disorders as a life-
style choice is prominent among pro-eating disorder 
websites, it is not espoused uniformly by all sites. A 
study by Csipke and Horne (2007) found that 54% 
of  pro-ana website users recruited through a mental 
health charity in the United Kingdom (n = 80) viewed 
anorexia and bulimia as clinical disorders; however, a 
significant number of  respondents validated the con-
cept of  eating disorders as a lifestyle adopted by choice
 It is likely that website creators conceptualize the 
phrase “lifestyle choice” differently from mental health 
professionals. In a grounded theory study of  pro-eat-
ing disorder websites, Norris et al. (2006) found that 
only one website (out of  a sample of  twelve) viewed 
AN as a lifestyle choice, whereas almost one half  of  
the website creators viewed their website as a means 
of  supporting individuals with eating disorders. The 
type of  support offered by these sites varies widely, and 
may range from connecting individuals to treatment 
options to promoting eating disordered behaviors. 

Offline Isolation and Online Community
 Issues involving isolation and community are 
prominent on pro-eating disorder websites. Norris et 
al. (2006) observed that “befriending the eating disor-
der leads to isolation from others,” and that pro-ana 
website users attempt to fill that void through inter-

action with other eating-disordered individuals. Users 
describe the need for isolation on 60% of  the sites, 
as exemplified by one user’s comment: “obese fatties 
around that want me to be just like them” (Borzekow-
ski, 2010). When an individual becomes isolated, he 
or she may find that the disorder creates conflict with 
other individuals. Tierney (2006) found that outpour-
ings of  anger or frustration towards “outsiders” (e.g., 
parents or doctors) were common and that outsiders 
were regarded as unaware of  the nature and bene-
fits pro-anas associated with their behavior. Results 
of  two studies suggest that the sense of  social isola-
tion increases as an eating disorder progresses, thus 
necessitating higher levels of  interaction with other 
users as the disorder becomes more severe (Serpell 
& Treasure, 2002; Serpell, Treasure, Teasdale, & Sulli-
van, 1999). One user described her sense of  isolation:

Unless you have a friend with ana, outsiders 
are not going to understand. Boyfriends are 
not so great to confide in, [because] if  they 
really love you, they won’t accept your starv-
ing for perfection; same goes with true friends 
(Gavin, Rodham, & Poyer, 2008, p. 330).

Discussion boards provide users with a space in 
which their identity is supported, accepted, and 
understood – something users believe cannot be 
achieved offline. One user posted: “I am so glad 
that I can come here and vent to you guys because 
you are so supportive and you never make me feel 
bad about myself ” (Gavin et al., 2008, p. 329).
 Pro-ana communities may serve a limited ther-
apeutic role for individuals who are not ready for 
therapy or who feel rejected by the medical com-
munity by providing the opportunity for individuals 
to express themselves in a supportive, anonymous 
setting (Petterson & Rosenvinge, 2002; Wilson et 
al., 2006). Juarascio et al. (2010) found that pro-ana 
groups on Facebook and MySpace contained positive 
social interactions between participants. Csipke and 
Horne (2007) suggest that social support is available 
on these sites and that visiting the sites can have a 
positive effect by drawing visitors out of  isolation. 
However, there is a distinction to be made between 
two types of  visitors: passive and active. Passive us-
ers do not interact with others during their usage of  
these sites, whereas active users utilize the sites’ in-

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75

teractive tools to connect with others. The findings 
of  Csipke and Horne (2007)’s study suggest that 
active participation on pro-eating disorder websites 
and seeking the support and friendship of  other 
visitors can have a positive perceived impact on in-
dividuals as they experience greater social support. 
 Csipke and Horne (2007) do not suggest that 
active users are immune to the dangers of  pro-eat-
ing disorder websites. They argue that the harm-
ful information shared during these interactions 
counteracts the positive gains from social support. 
Active users may be vulnerable to a different set 
of  dangers than passive users because active us-
ers are more likely to utilize the social support to 
motivate each other to engage in pro-eating disor-
der behavior. While it is clear that active users and 
passive users experience the sites differently, it is 
unclear which factor leads individuals to become 
more symptomatic: isolation (passive users) or mo-
tivation to become eating disordered (active users).  
 Issues of  social isolation are frequently raised on 
social networking sites (Juarascio, Shoaib, & Timko, 
2010). Posters request advice about family and re-
lationship problems, which sometimes, but not al-
ways, surrounded eating disorder issues; posed ques-
tions and entered into discussions of  sexuality; and 
shared life problems. One user shared her problem 
that simultaneously involves a romantic relationship 
and her eating disorder: “Sometimes I really want 
to tell my [boyfriend] about this because secretly 
I want him to be supportive but I know he would 
never understand (Gavin et al., 2008).” Upon join-
ing a new group, individuals may introduce them-
selves with statistics that describe their weight, age, 
and height. For example, one member introduced 
herself  to the group through the following post:

Name: [removed]. Height: 5’3, high weight: 160 
(I was pregnant), low weight: 85, current weight: 
98, goal weight: I’ll never be content w/ any 
number to be honest (Juarascio et al., 2010, p. 7).

Other introductions to the group included informa-
tion such as relationship status, years with an eating 
disorder, and reason for joining the group. In con-
trast with the unemotional tone of  introduction and 
disclosure, statements of  support and friendship 

tended to be highly emotional. Examples included 
members requesting friendship due to feelings of  
extreme loneliness and isolation, advice or feedback 
about relationships, and emotional support. For ex-
ample, when one member mentioned having to at-
tend a holiday party, another member responded, 
“You can do it!!! Just think of  the end results! It’s 
been hard for me. Holidays are hard, so much food 
thrown in your face all the time! You are strong!” 
(Juarascio et al., 2010, p. 7). It was common to of-
fer to communicate outside of  the social network-
ing site, such as on the phone, via email, or chat. 
 Despite the positive gains from social interac-
tion, discussion boards provide information that 
often runs counter to recovery, including sharing 
tips and tricks to hide disordered eating behaviors 
from health care professionals, family, and friends, 
thereby staving off  hospitalization and professional 
support. Though social support may be gained on-
line, isolation from offline sources of  social support 
(family, friends, community, etc.) will inevitably in-
crease as the disease progresses (Gavin et al., 2008). 

Claims to Authenticity
 Antagonism toward “wannarexics” seems to be 
common among pro-ana groups (Boero & Pascoe, 
2012). The term describes individuals who are per-
ceived to emulate eating disorders and visit pro-ana 
websites hoping to adopt the attitudes, behaviors, 
and weight loss results they promote. The antag-
onism directed at wannarexics may represent the 
struggle between online exclusivity and offline isola-
tion. In their study, Borzekowski et al. (2010) found 
that 32% (n = 57) of  the sites had an overt tone or 
statement directed to “wannabes.” Both polite and 
antagonistic statements were identified. One polite 
statement was, “If  you are looking to become an-
orexic or become bulimic by being here then please 
leave.” One example of  a harsh statement was:

IF YOU WANT TO LOSE WEIGHT, GO ON 
A DIET FATTY. ONE IS EITHER ANA/
MIA, OR NOT. IT IS A GIFT AND YOU 
CANNOT DECIDE TO HAVE AN EATING 
DISORDER. SO IF YOU ARE LOOKING 
FOR A WAY TO LOSE WEIGHT, S-S-S-

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76

SORRY, JUNIOR!! MOVE ON, TRY JENNY 
CRAIG (Borzekowski et al., 2010, p. 1528). 

Requests for tip giving may be met with reluctance or an-
tagonism. When one poster in a MySpace group request-
ed tips on how to purge, another member responded:

Ugh don’t even try to do it. I went through trying 
and failing to be able to throw up for a couple 
months. Yeah I can do it now but sometimes it 
happens even when I don’t want. I hate doing it 
but I can’t stop. Its’ [sic] not worth starting and it’s 
not cool that you are asking for this kind of  ad-
vice here. It sounds like you don’t even really have 
an eating disorder (Juarascio et al., 2010, p. 8).

Group members routinely challenge wannarexics on 
their lack of  knowledge around weight-loss strate-
gies. Boero and Pascoe (2012) suggest that users may 
demand the self-representation be authentic in or-
der to maintain a sense of  community. Authenticity 
is assured through a series of  group rituals, such as 
weigh-ins and posting pictures, which allow users to-
tal claim to a pro-ana identity while depriving others 
of  it. The relationship between isolation offline and 
exclusivity online is a topic that merits further study.
 When users fail to participate in group activities 
they are met with scorn and suspicion from other mem-
bers. Posting pictures that show dramatic weight loss 
are an important part of  proving an authentic pro-ana 
identity and the use of  celebrity thinspiration instead 
of  a self-portrait invites criticism. One member posted:

You can always pick the wannabes, the ones with 
only skinny celebs in their pictures and a whole 
ton of  pro-ana crap on their MySpace. I bet if  
you asked them why they don’t have any pictures 
it would be because they “just like started being 
ana like 5 weeks ago” (Boero & Pascoe, 2012).

Sometimes users attempt to smoke out interlopers by 
issuing alerts:

…there is deffy one person on this site, who 
you can just tell has NOT got an ED. I know, 
you cant tell over the web, but you can by her 

comments & her stupid posts on the subjects etc. 
A number of  people on my msn who visit this 
site have also spoken about her on numours(sp) 
occasions, so I know for a fact, I am not the 
only one who has noticed this…(Giles, 2006). 

The antagonism toward wannarexics suggests that 
the community boundaries on these sites are close-
ly monitored and protected. Giles (2006) notes that 
if  anorexia is about attempting the unachievable, 
then it is not surprising that anorexics set such high 
standards for admittance to their community. It 
seems that these statements have important impli-
cations for the maintenance of  the ana identity and 
possibly serve to compensate for offline isolation.

Implications for Eating-Disordered Behavior
 The danger in these tips and tricks that appear 
on these websites is not only the content of  their 
message, but also in their prominence on pro-eat-
ing disorder websites. Cultivation theory, developed 
by communication scholar George Gerbner, pos-
its that when messages are pervasive and repeated, 
individuals with higher exposure levels are more 
likely to accept the conveyed messages as nor-
mative (Borzekowski et al., 2010; Gerbner, 1998; 
Heath and Bryant, 2000). Thus individuals who fre-
quent these websites may come to view methods 
of  extreme dieting and exercise as normal behav-
ior rather than symptomatic of  an eating disorder. 
 Research suggests that even modest exposure 
to pro-eating disorder websites may encourage sig-
nificant changes in caloric intake and increased dis-
ordered eating behaviors, and that even greater ex-
posures to these websites by at-risk females may 
contribute to the development of  eating disorders 
(Jett, Laporte, & Wanchisn, 2010). In this study, un-
dergraduate females with no history of  eating dis-
orders and a BMI greater than 18 were assigned to 
one of  three conditions. The exclusion of  women 
with eating disorders makes this study unique among 
others studying the effects of  pro-ana viewership. 
 The first condition was exposed to pro-eating 
disorder websites for a total of  90 minutes, the sec-
ond condition to health and exercise websites, and 
the third condition to tourist websites. All partici-

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77

pants were asked to keep food diaries prior to and 
following exposure to one of  the three types of  web-
sites. The pro-eating disorder websites were chosen 
because they included the Ana Creed, tips and tricks 
on how to be anorexic or bulimic, and thinspiration. 
Eighty-four percent (n = 21) in the pro-eating dis-
order condition reduced their weekly caloric intake 
by an average of  2470 calories. In contrast the par-
ticipants in the other conditions did not reduce their 
caloric intake by a significant amount. Even though 
84% of  subjects in the pro-eating disorder group re-
duced their caloric intake, only 56% perceived that the 
websites influenced them to reduce their food intake 
(Jett et al., 2010). This discrepancy speaks to a lack of  
insight regarding influences on body image and eat-
ing habits. The age of  participants represents a weak-
ness of  this study since pro-ED viewership begins up 
to a decade earlier (Custers, 2009). Using a younger 
sample might yield a more relevant understanding of  
the effects of  pro-ana viewership. In addition, keep-
ing food diaries may have cued participants into the 
true nature of  the study and sensitized participants 
to their food intake, which may partially explain the 
decreased caloric intake among the sample that was 
primed to weight-loss through viewing pro-ana web-
sites. Lastly, the long term effects were not studied 
which may represent an ethical problem. Researchers 
followed up with participants three weeks after expo-
sure in order to assess eating disordered behavior and 
attitudes as a result of  the study (and found none). 
However, it remains unclear if  viewing pro-ana con-
tent even for a short period of  time has lasting effects. 
 A prospective study found that viewing pro-an-
orexia websites led to greater negative affect, lower 
self-esteem, and lower satisfaction with appearance 
as well as an increased likelihood of  identifying one-
self  as heavy, of  exercising, of  thinking about one’s 
weight, and of  engaging in image comparison (Bar-
done-Cone & Cass, 2007). Fourteen percent (n = 33) 
of  this study’s participants had a score of  20 or above 
on the Eating Attitudes Test (EAT-26), which sug-
gests the presence of  an eating disorder. Lastly, in-
dividuals who frequent pro-eating disorder websites 
report higher levels of  body dissatisfaction and eating 
disturbances (Harper, Sperry, & Thompson, 2008). 
This does not suggest a causal relationship between 

pro-eating disorder websites and body dissatisfaction 
and eating disturbances, rather it suggest a correlation. 
 Competition among users and social compar-
ison features prominently in pro-ana communities 
(Rouleau & von Ranson, 2011). Competition in the 
area of  extreme weight loss can be conceptualized 
by the work of  Albert Bandura, whose social cog-
nitive theory proposes that modeled behaviors are 
more likely to be imitated when message receivers 
can relate to the model and perceive rewards with the 
communicated behavior (Bandura, 1989). With this 
model in mind, it is easy to see how copying other 
users’ behavior leads to a culture of  “one-upman-
ship” that fosters competition. Csipke and Horne 
(2007) found that 19% (n = 29) of  pro-eating disor-
der website users reported that the sites were harm-
ful because of  their promotion of  competition and 
disordered eating among users. Thus individuals who 
view others’ extreme weight loss as achievable and 
desirable are more likely than others to adopt the 
behaviors modeled by their online peers. It appears 
that competition and self-comparison among mem-
bers of  an online group may be a motivating factor 
in the maintenance of  eating disordered behaviors. 

Discussion
 The pro-ana community seems to struggle with 
many internal conflicts and contradictions that may 
be considered from a psychodynamic perspective. 
These internal conflicts and contradictions allow for 
the conceptualization of  eating disorders as a spec-
trum disorder with poor body image at one end and 
clinical AN at the other (Patton, 1988). In the pro-ana 
community there is a marked struggle between online 
exclusivity and offline isolation. It appears that the 
construction of  an authentic class of  anas is formed 
in reaction to low levels of  social support offline. 
While a user may feel alone and detached from her 
offline community, she may be valued by others for 
her contributions to an online community where she 
finds high levels of  social support from other users. 
In order to be accepted online, a user must prove his 
or her ana identity or be cast out as a wannabe. There 
does not appear to be a space for users who are in the 
beginning stages of  the disease or who have not fully 
adopted the missions and goals of  a website. Pro-

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78

ana websites provide more than a collection of  tips 
and tricks and thinspiration –they also provide a val-
idation arena for exploration of  the pro-ana identity. 
 Another struggle within the pro-ana community 
is whether to consider the eating disorder a “gift.” 
The conception of  anorexia as a gift reinforces the 
exclusion of  wannabes by telling them they can never 
adopt the ana identity and thus do not belong. The 
confusion about anorexia as a boon or damnation is 
felt not only at the community level but also at an 
individual level. Within this struggle the question of  
control arises: does a user enjoy the gift of  an eating 
disorder at will or does the eating disorder control 
and trap the user? Are authentic anas able to use and 
dispose of  the pro-ana identity or are they trapped 
within it? While users may feel they can control 
their bodies through anorectic behaviors, they may 
also feel that anorexia has seized control of  their 
identities, bodies, thoughts, feelings, and actions. 
 Lastly, there is confusion about where the pro-
ana identity lies. An individual may be pro-ana 
or she may be controlled by a pro-ana influence. 
Some website users refer to anorexia as a personi-
fied being (called Ana), who is portrayed as con-
trolling, demanding, and perfectionistic, and is fre-
quently distinct from an individual’s view of  the 
self. Separating oneself  from Ana may be a defense 
that allows an individual to preserve her identity 
while accommodating the influence of  the disease. 
 Alternatively the pro-ana identity may be so in-
ternalized that there is no separation between one-
self  and Ana.  The fact that Ana and Mia are fe-
male names gives rise to the conception of  Ana 
and Mia as female influences that may be friends, 
enemies, or both simultaneously. The pro-ana 
community experiences many sources of  internal 
conflict that are an extension of  conflicts experi-
enced on an individual level by users with anorexia. 

Conclusion
 While the nature of  pro-eating disorder web-
sites has been elucidated over the past decade, there 
remains the problem of  how to counteract the risk 
to users of  accessing these websites. In response to 
public pressure, some internet platforms have shut 
down pro-eating disorder websites. While this tem-

porarily thwarts access to these websites, it is not a 
permanent solution. For example, in the early 2000s 
Yahoo! and MSN shut down several pro-eating dis-
order websites at the urging of  media, clinicians, and 
professional organizations (Hammersley & Tresed-
er, 2007). However the websites reemerged on oth-
er platforms or behind the guise of  “pro-recovery” 
websites, which frequently offered the same content 
found on pro-eating disorder websites (Lewis & Ar-
buthnott, 2012). In addition, there is the question: is 
shutting pro-eating disorder websites in the best in-
terest of  public health? Lewis and Arbuthnott (2012) 
note that searches on “suicide methods” yield both 
relevant content and a sidebar with contact infor-
mation for a crisis hotline, which may be an effec-
tive intervention to suicide ideation. Thus one pos-
sible strategy would involve offering eating disorder 
treatment information in addition to the pro-eating 
disorder websites when a user searches for certain 
keywords, such as “pro-ana” or “thinspiration.” 
 For their study on users’ opinions of  pro-eating 
disorder websites Csipke and Horne (2007) recruit-
ed participants online. The majority of  respondents 
(84%, n = 127) reported having an eating disorder. 
Their study found that a large group of  participants 
(41%, n = 61) visited pro-eating disorder websites 
several times a day, and sixteen participants (11%) 
visited them at least once a day. Only nine partici-
pants reported having visited a pro-eating disorder 
website only once. If  an individual enjoys the com-
munity found on websites, then he or she may ben-
efit from websites that genuinely support recovery 
and do not allow pro-ana content. This is a poten-
tial avenue of  treatment to be considered by clini-
cians as well as a topic to be studies by researchers 
who wish to understand the effects of  pro-recovery 
websites on formerly eating-disordered individuals. 
 Future studies should seek to identify modera-
tors that strengthen the effects of  pro-ana viewer-
ship. Studies should also investigate at what point 
over the course of  an eating disorder an individual 
is most likely to first access pro-ana sites. The an-
swers to both of  these questions could lead to a 
more nuanced understanding of  the relationship be-
tween pro-ana viewership and the maintenance of  
an eating disorder, which could have implications 

I WILL NOT EAT! A REVIEW OF THE ONLINE PRO-ANA MOVEMENT



79

for primary interventions as well as a more accurate 
portrait of  an individual’s eating disorder etiology. 
 While this paper reviewed studies on the role of  
pro-eating disorder websites in relation to the sus-
tainment of  eating disorders, the role of  these sites 
at the beginning of  a disorder has yet to be elucidat-
ed. While it is unlikely that viewing pro-eating dis-
order websites would be the sole cause of  an eating 
disorder, it would be worthwhile to investigate their 
role among individuals who have yet to develop an 
eating disorder, but are tentatively experimenting 
with eating disordered behavior. Understanding the 
role of  pro-ana viewership at different stages of  an 
eating disorder will enhance treatment of  eating dis-
orders, as well as provide new avenues of  research. 

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