Eating Disorders Online: Support or Triggers?

A new article looks at online content that promotes eating disorders in 2015

Posted Aug 03, 2015

In the early 2000s, a great deal of concern was raised about websites that endorsed and even promoted eating disorders such as anorexia and bulimia.  The alarm over pro-ana (anorexia) and pro-mia (bulimia) websites was even loud enough to trigger an episode of the Oprah Winfrey Show in October 2001 on the subject.  But what has happened since? The online world has certainly changed, but what about the pro-eating disorder message? 

In a recent issue of the European Journal of Pediatrics, Belgian researcher Kathleen Custers tries to provide an update on the trends and describe what researchers actually know at this point about the effects of pro-eating disorder messages online. 

While the subject remains infrequently studied, a number of conclusions stand out.  First, this content remains widely available and heavily accessed.   Rough estimates are that approximately 13% of young female teens in general have visited pro-ED sites with the rate nearly tripling among those who manifest problematic eating disorder behaviors.  Another study reported that pro-ED content is searched on Google 13 million times per year. 

Secondly, the sites have not changed drastically in terms of content or demographic. While social media has provided more of a venue for interaction, the content of the sites themselves continue frequently to display “thinspiration” photos of extremely thin women (sometimes photoshopped to make people look even thinner) while often describing tips and tricks that can be used to lose weight and evade detection.  These themes are not uncommonly expressed in pseudo religious terms, for example, “thin commandments.” 

While the airing of such topics certainly cause apprehension in many, some controversy exists about how destructive this content actually is.  Given the alienation that many individuals with eating disorder symptoms experience, some have argued that these sites provide a rare space for nonjudgmental support and reflection and thus may actually be beneficial to some.  Research data, however, tends to demonstrate more harmful effects.  Survey studies have shown that those who visit these sites report more dissatisfaction with their appearance as they pick up new methods of weight loss.  The chicken or egg question, however, can easily be raised here as it is likely that some of these feelings are driving traffic to these sites rather than the other way around.  More solid evidence comes from a few studies that have turned to more experimental models in which usually college age women are randomly assigned to viewing pro-eating disorder sites versus other type of content.  Some of these studies have found similar results as the surveys, and in a small percentage of subjects the viewing has promoted intense calorie restriction.

The article concludes with some advice for both health professionals and parents.  Clinicians are encouraged to become acquainted with pro-ED messages on the internet, ask their patients and clients about it, and even encourage the use of an online media diary (good luck with that one).  The author does not advise clinicians to expressly forbid patients to go to those sites who are not yet ready to consider changing their behavior.   

Personally, I wondered also if bringing up the topic might actually cause some youth to explore these sites even more.  Clinicians have been taught for years that you can’t induce serious suicidal thinking in people by bringing up the subject, but this seems a little different.  At the same time, it is difficult to think that I would be ahead of any of my child and adolescent patients when it comes to knowing about things online.

Parents also are reminded to be mindful of these sites, especially with how easily they can now be accessed with portable devices anytime and almost anywhere.

The article was a nice reminder that this topic has not disappeared with AOL but is taking different forms.  While few would argue that culture and media are the sole drivers of eating disorders, their role is clearly important and deserving of this kind of investigation.

@copyright by David Rettew, MD

David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.

Follow him at @PediPsych and like PediPsych on Facebook.