Michelle, a 19-year-old girl from Texas, has been battling anorexia and bulimia for eight years, her weight swinging from 87 pounds to 183. She's been in and out of hospitals; she's suffered from bipolar disorder, drug abuse and self-mutilation. After her last stint in the hospital and a miscarriage, she returned to anorexia about three months ago. She got online and typed the words "anorexia and bulimia" into a search engine, hoping to find a Web site that might help her in her battle to be thin.
Boy, did she hit the jackpot. Michelle (not her real name) is now a proud member of the pro-anorexia movement: a growing, not-so-secret online community of anorexics who have taken the "I'm OK, you're OK" ideals of group therapy to a twisted new level. Not only do the pro-anorexics offer one another unconditional love and understanding, they also swap starvation diet tips, participate in group fasts, offer advice on how to hide your "ana" from nosy family members and share inspirational pictures of emaciated models like Kate Moss.
In a world that stigmatizes anorexics as sick people who need professional help, the pro-anorexia community tells its brood that they don't need to be fixed, that weighing 87 pounds is beautiful and that being unhappy is just fine, as long as you're skinny.
"For those people who want to get better or those who think that being the way they are is good, that's wonderful that they think that way," explains Michelle. "We applaud them for being happy with who they are. We simply aren't in that position."
Anorexics have always defiantly banded together when given the opportunity, but never with such ease, on such a grand scale. Experts regard the rise of these groups with consternation: "They seek each other out as consolation," says Steven Levenkron, psychotherapist and author of "Anatomy of Anorexia." "It's a lot of denial and a lot of compensation: If you're stuck with something that you know makes you different and not so healthy, you're going to develop a whole repertoire and lexicon of 'up' statements to make yourself feel better, recruit more people, and take you out of your isolation and depression."
In other words, until forced to do otherwise, these anorexics will persist in believing that thinness will bring happiness; and not only does the pro-ana community help maintain this delusion, it's a place where anorexics can escape the concerned eyes of friends, family and doctors -- as well as learn how to fool them. As one woman put it, in the "Dying to Be Thin" group, "These sites are for people with anorexia to come and be honest about their feelings, without having to be about being judged or lectured ... So what if some people would rather be dead than fat -- society has already told us that fat people do not belong."
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The 10 Pro-Ana Commandments
1) If you aren't thin you aren't attractive.
2) Being thin is more important than being healthy.
3) You must buy clothes, cut your hair, take laxatives, starve yourself, do anything to make yourself look thinner.
4) Thou shall not eat without feeling guilty.
5) Thou shall not eat fattening food without punishing oneself afterwards.
6) Thou shall count calories and restrict intake accordingly.
7) What the scale says is the most important thing.
8) Losing weight is good/gaining weight is bad.
9) You can never be too thin.
10) Being thin and not eating are signs of true will power and success.
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The term "pro-ana," as specific as it seems, has various meanings for people in the pro-ana community. One 16-year-old girl said in an e-mail interview that it simply means "people who don't want to recover yet." Michelle sees it more as a support group: "We are just saying that there is nothing wrong with each person who has an eating disorder." But many others seem to think that anorexia is a badge of honor, something to aspire to, such as Jai, who runs one of the biggest pro-ana sites: "I think that anorexia is great, just as long you know how to handle it."
A quick review of the pro-anorexia communities hosted by Yahoo conveys this blithe attitude in abundance. There's Pro-Anorexia, for "People who are/want to be anorexic." There's a club called aNOreXiC WaNNa B and The Thinner Is the Winner, "a club for people who strive to be thin." Pro-anorexics can join Anorexia for Life, My Friend Ana, Pro Ana Sanctuary, StickThinPixies, Always Anorexia, love ana, I Love You to the Bone, Fading to Nothing, Bonelovers, the truly specialized Pro Ana Hanson Fans and dozens of other pro-anorexic clubs. Many have literally thousands of members, which isn't surprising: According to widely accepted figures provided by the American Anorexia Bulimia Association, there are more than 5 million anorexics in the U.S., where 3 percent of all women have eating disorders. One percent of all teenage girls are anorexic; 10 percent of those will die from the disorder, and a third will probably suffer from it for the rest of their lives.
Not all of these clubs blatantly advocate anorexia as an acceptable "lifestyle," but all of them are filled with members who will happily offer tips on how to become a "better" anorexic. And the best anorexic, of course, is a dead anorexic: In a sense, pro-anorexia is pro-suicide for at least 10 percent of its supplicants. As Charity, a 15-year-old pro-anorexic from England, fatalistically puts it, "The winner dies."
The advice that the (mostly) women and girls in these clubs offer is often horrifying: There's advice on caffeine pills, diet pills, laxatives, pills that prevent the absorption of fat and how to avoid getting blood in your vomit. You can find out which foods contain "negative calories," read up on a hundred different diets and find out how to hide food so your family doesn't know you're not eating. (Hide food up your sleeves! Feed your pet! Disguise a Jenny Craig bar in a Snickers wrapper!) There are pat "excuses" for when your friends and family bug you about eating: "The doctor said I shouldn't have too much fat." "I'm vegan/vegetarian/on a diet." "I can't eat hot stuff."
A popular pastime is the group fast, in which a group of pro-anorexics stops eating for days at a time in a show of solidarity and support. There are many "lose 20 pounds in a month" clubs as well. Pro-anas enthusiastically relate advice and encouragement for long-term hunger strikers, skipping the part about an inevitable trip to the hospital, if not the morgue. One poster received this response when she queried a pro-ana mailing list on how to fast for three months: "3 months? You're the best anorexic ever!"
Indeed, the pro-ana online community is not just about support, it's about competition. As Lynn Ponton, professor of psychiatry at the University of California at San Francisco and author of the upcoming book "Risking the Body," explains, "The girls are not only collaborative, but competitive: They want to be the thinnest."
There are, of course, many posts in which sad, confused and lonely girls (and the majority of pro-anas do seem to be teenage girls) bare their souls about their unhappiness -- tales of divorced parents, broken hearts, feelings of isolation and suicide attempts. And for these emotional rants they receive lots of loving support in response. But the majority of the chatter is nuts-and-bolts: diet tips, advice and "triggering" pictures (a medical term that the self-conscious pro-anas have reclaimed for their own use): photographs of skinny models and celebrities that inspire anorexics in their quests. Particularly popular are photo galleries of Christina Aguilera, Kate Moss, Posh Spice, Calista Flockhart, Lara Flynn Boyle, Jennifer Aniston and any number of itsy-bitsy models.
Besides the mailing lists and bulletin boards, there are countless pro-ana home pages where anorexic girls offer yet more tips and photographs, plus food diaries and inspirational advice. Charity even offers an advice column. (To "Terri," who writes, "I just haven't been able to control my cravings ... I'm so, so huge. I'm 5'5" tall, and I weigh 105 lbs. I can't bare it," Charity offers this inspirational advice: "Go to http://www.uglypeople.com and look at all the ugly people. Most of the females are ugly and FAT.")
Many of the tips are the same kind of diet advice that you might glean from any women's magazine -- "Take a sip of water in between every bite. It will fill you up twice as fast as just eating" -- but it takes on a disturbing sheen when adapted to help girls who weigh 110 pounds reach their goal of 86 pounds.
There are plenty of visitors to the pro-ana Web sites who are healthy girls looking for ways to shed a few pounds before prom night. But the true pathology of the disease is evident in the more extreme weight loss "thinspiration," stuff you'd never see in Self or Cosmopolitan: "Play with your metabolism. Take 800 cals one day and starve the next ... the next day you can take 700 cals and the next you can take 300 cals, you'll see your weight drop quite a bit." "Sugar-free gum is one of the best things. Not only will you trick your mouth, but you can stop the stomach rumblies for a while chewing it." And: "Try and eat if you get very sick. If you don't you have a high risk of fainting and letting them worry about you. If they worry you lose the game."
Megan Warin, an anthropology/sociology Ph.D. candidate in Australia, recently identified the "cult of anorexia" -- an obsessive aspect of the eating disorder that leads to the creation of a secret club with its own codes and behaviors and in which only the other members truly understand the rules. This is what the pro-anorexia movement embodies and offers to its members: a group of like-minded people who share a very specific pathology.
Ironically, it is not unlike the 12-step phenomenon, only the goal is illness instead of freedom from illness. As 15-year-old Jai puts it on her home page, "There are some people I've seen that call people sick and stuff for being pro ana, but I just ignore them because they don't understand anorexia the way people in the pro anorexia web rings do. I guess they won't understand until they experience what we experience. People who live around me don't know anything about my anorexia."
The pro-anorexia movement is not a development that is entirely new. Therapists have been observing this kind of behavior in hospitals for years. Girls who are admitted to an eating disorder program will band together: "When girls live and go to a group together we get symptom pooling," says Levenkron. "People who have just been restrictors [who severely limit their caloric intake] learn about laxatives and vomiting and exercise and diuretics and enemas. It becomes a culture -- they begin to bond. They find there are people like them and they are relieved because they aren't so crazy."
But in scale, hospitals can't compare with the Internet, where curious anorexics can instantly find thousands of other anorexics to chat with. On a fundamental level, anorexics are seeking friendship and support; and frightening as it may be, the pro-anorexia movement gives that to them. But this vast cyber-bond, offering the constant companionship of people who uphold the collective delusion that eating a half-cup a rice and a cube of jello a day is perfectly fine, makes therapists extremely nervous. "These sites are dangerous," says Ponton. "It normalizes anorexia."
In fact, even writing about the sites offers a bit of a conundrum: The last thing you want to do is point sick anorexics toward the groups if they don't already know about them. As Warin put it, when she declined to be interviewed for "ethical reasons": "I know people with anorexia who do not know about these sites, but once given the information, they will access them to support and extend an illness that is a sure road to a life of misery and possibly death."
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A post from the Paperweight Perfection bulletin board:
Ladies, if you are in your teen years and want a boyfriend you better never get fat. Because everyone knows that hot guys only go for the skinny girls with big boobs. I hate it when guys say that size doesn't matter, that is the biggest fucking lie in the whole universe!!!!! If size doesn't matter then why are none of the fat girls popular in high school?
That is why we anorexics have to give off the right image, we have to be skinny and make all of the popular guys like us, but then turn them down or expose them as the mean people they are by saying something like, "how come you never liked me when i was fat?" We also have to not be like the rest of the fucked up world, we have to see people for what they are inside and act nice to everyone, regardless of their size! I am totally Pro anorexic, but i am just saying that we all, all of the pro anorexics out there, have to band together and raise to a higher level above this fucked up society.
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A lot of chronic anorexics actually attempt to recruit others to their "lifestyle" to feel better about themselves. "There are a whole lot of people who haven't given up yet and could recover; for those people, to get involved in pro-anorexia, it's like taking the kid who stole a pencil and putting him in a maximum-security prison," says Levenkron. "It's going to change those girls -- the girls will absorb the idea that you never get better."
But the pro-anorexics don't seem to be very worried that they are wooing others to their lifestyle. Charity offers typically circuitous logic about this: "If a young girl or boy is smart enough to know about pro-anorexia -- smart enough to find [it] online and smart enough to read through everything -- then they're not likely to kill themselves."
Michelle also claims that pro-anorexic sites are no more "triggering" than a copy of Vogue magazine. "You can't turn the page of a magazine without seeing triggering pictures of beautiful models whose ribs show or whose collarbones are accented by what they are wearing," she says. "Society glamorized the anorexic look. Turn on the television and what do you see? Slim Fast commercials. Society itself constantly promotes anorexic looks." (And even promotes it among anorexics, it seems: After I joined a few pro-anorexia clubs, Yahoo began serving me ads that promised to help me lose 10 pounds in a month at eDiets.com.)
To be sure, the collections of posts and pictures in the pro-anorexia groups are, if nothing else, clear proof of how detrimental the cultural cult of thinness is to the delicate psyche of a 14-year-old girl. Each club has a photograph of a stick-thin model as an icon -- never mind that many of those models themselves have eating disorders and drug-addiction problems, and certainly are no happier than the teenage girls who aspire to be them. As one girl poignantly posted in the "Always Anorexia" forums, "Seems like nothing in this life is ever easy ... except for those super thin models we're trying to look like. Why is it so easy for them?" The answer that the pro-anas don't seem to get, sadly, is that it isn't easy for models either.
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I want to weigh like I weighed in the 4th grade.
I want to be left alone.
I want to vanish.
I want to be able to go through a whole day without thinking about how many calories I've eaten.
I want to eat a piece of cake without crying. I want to look at the mirror without feeling horror.
I want to go on the scale and say "Wow that's great I've reached my goal, now I can stop."
I want to love myself.
-- From the home page of Liz, a 14-year-old pro-ana
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There are those who believe that they can infiltrate the pro-anorexia groups and help heal some of the sufferers they find there. Katie, an 18-year-old former anorexic from Michigan, suffered from the disease for three years, ending up in the hospital at 5-11 and 105 pounds, unable to even walk. These days, she hangs out in the Pro-Anorexia mailing list and offers the wisdom of her experience.
"I go there in hopes of talking sense into most of the girls, to shine the light of common sense on their destructive pursuits ... That has been the most helpful result of finding the group. Talking with people who understand me is priceless," Katie says. "But if I had found the group while still stuck in the depths of my eating disorder, it would have been horrible. To have the support and the advice, the resources and voices of experience all pointing me towards weight loss ... I would have been much worse."
The nascent movement to combat the pro-anorexia groups is even seeking (rather naively) to ban the pro-anorexia groups. The pro-anorexia mailing lists are increasingly peppered with the well-intentioned pleas of concerned posters who hope to talk the pro-anas out of their destructive ways. Unfortunately, the pleas seem to do very little except encourage the pro-anorexics to circle their wagons and go on the defense. And unless parents are actively screening every Web site their daughter visits or all the e-mail she receives, it's unlikely they'll ever know that their child belongs to the pro-ana movement.
The fact is, say experts, that anorexics, like any other kind of addict, can't be helped until they want to be helped. And the mantra of the pro-anorexic movement is that you don't need to be helped. The good news, however, is that when an anorexic decides that she does need help, there are resource sites like S.C.a.R.E.D., or communities that offer peer counseling, medical advice and support. The hope is that they'll get there before it's too late, before the warped illusion of control, the idea that happiness is just a few pounds out of reach if you have the discipline to get there, destroys their bodies forever.
"These girls need enormous support. At the same time, the medical-societal trend is to provide smaller amounts of funding for treatment," says Levenkron. "So they are turning to the people who say 'Don't worry honey, join our group and you'll feel good.' Medical and health insurance is offering less; and despairing chronics are, on a morale level, offering more. This will continue to proliferate until society says, 'Come back and belong to us.'"
Meanwhile, the pro-anorexics seem to think that what they have is better than nothing at all. Says Michelle, "I don't want to be anorexic for the rest of my life. I just want to find a comfortable weight to get at where I can take control of the situation completely. I will begin to eat more healthily and exercise as usual. And when I look at myself I will not only smile, but will be proud at what I have worked hard to achieve."