The Pro-ED Cycle

The Pro-ED Cycle

Jaclyn O’Rorke

Dr. Johns

December 7, 2011

Introduction

The advent of the Internet has transformed how people access information and how they communicate with one another. By the late 1990s it was evident that the Internet had become a powerful new social institution (Cotten, 2001). In 2011, the internet can be accessed via cellular phone and one can connect to the Internet utilizing free WiFi zones that are offered by numerous businesses including restaurants, universities, libraries, hotels, and cafes. The United States is home to over 300 million people and of those 300 million, 228,110,000 citizens have regular access to the Internet according to the 2010 Census (U.S. Census Bureau, 2011).

About 5% of all web searches are health-related, even though both the quality of content provided and the comprehension level of the Internet user may vary (Bell, 2007). Information about diseases and disorders of both the mental and physical variety are plentiful, and there are also forums where people post and discuss their illnesses and bond over treatments and offer mutual support during periods of sickness. One can type almost anything into a search engine and pull up thousands of the sites for whatever their heart desires. This certainly holds true for the subject of eating disorders. Eating disorders have the highest mortality rate of any mental illness in the world and affect more than 11 million Americans (NEDA, 2005).

Online one can find a plethora of information regarding eating disorders, including pro-anorexia and pro-bulimia sites. Most of the sites offer tips and tricks on how to lose weight and how to hide the illness from others. There are also pictures of extremely skinny women called thinspiration, a credo about being pro-eating disorder and typically a forum where Internet users can post or blog about their experiences as it relates to food, weight, their eating disorders, treatment, or life in general. With such a vast number of the American population online and the attempts to ban pro-anorexic and pro-bulimia sites proving to be highly ineffective, it is imperative to study how these websites are affecting those who view them. Some argue that extreme online communities such as pro-eating disorder websites provide an outlet for those with eating disorders to discuss their illness amongst peers. However, I argue that these sites are extremely detrimental to recovery and that they conjure negative self-esteem and bad body image even in healthy individuals that have previously not been fixated with weight. For those that do have pre-existing issues with their body image, the sites can only perpetuate the cycle of an eating disorder.

Background

Eating disorders are one of the most deadly mental illnesses. Less than half of those who develop an eating disorder ever fully recover. There are several types of eating disorders, but the most commonly discussed eating disorders found on pro-eating disorder sites are anorexia, bulimia, and eating disorder not specified. On pro-eating disorder sites, if one supports or have anorexia they are known as pro-ana and if they support or have bulimia they are known as pro-mia. Eating disorder not specified or EDNOS refers to an individual that has not been diagnosed specifically with an eating disorder but adopts the signs and symptoms of those with an eating disorder, but not enough to be fully diagnosed. Other eating disorders that are briefly discussed but not the main topic on pro-eating disorder sites include Binge Eating Disorder which is similar to bulimia except that no compensatory measures are made to counter the mass food consumption and orthorexia which involves extreme obsession of healthy eating. Contrary to popular belief, an individual can have more than one type of eating disorder using several methods to obtain weight loss or cycling between being anorexic and being bulimic. Regardless, these eating disorders affect every aspect of one’s life as it takes both a toll on the body and the mind.

Anorexia nervosa is the most deadly eating disorder of them all. It is marked by self-starvation and rapid weight loss. Starving oneself obviously leads to malnutrition, which in turn affects nearly every organ in the human body. For example, when an anoretic starves herself to the point where her total body fat is less than 20 percent of her total body weight, hormonal imbalances and amenorrhea or the cessation of menses occurs. The majority of sufferers of eating disorders are young girls in their teens, and the cessation of menses can result in stunted or delayed growth. Prolonged cases of amenorrhea leads to bone loss. For both men and women that suffer from anorexia, serious renal system complications occur as they restrict or overload fluid intake. Obvious effects of dramatic changes in fluid intake can result in dehydration, cerebal edema, seizures, and ultimately death. In men and women, there are also serious gastrointestinal effects such as the rupturing of the stomach along with the less serious chronic constipation, gas, belching, and bloating. Furthermore, the heart is affected and irregular heart beat, cardiac arrest, and death can result. (Boskind, 2000). For young women, ages 15-24 the mortality rate from anorexia is twelve times higher than all other causes of death (NEDA, 2005).

Bulimia, the other most common eating disorder, as about half of those with anorexia eventually develop bulimia(NAMI, 2011). Bulimia is discernible by the cycle of bingeing and the following use of compensatory measures to counter the binge eating. Binge eating refers to eating large quantities of food; typically during a binge the bulimic is drawn to high-calorie junk food. Many bulimics have to go to great lengths to hide this habit and to obtain the funds to support the habit of buying massive amounts of food. After a binge, bulimics have expressed that they feel extreme guilt and disgust at having consumed so much so they will use any method possible to get the calories off that they just put on. There are two methods of doing this: the purging method and the non-purging method.

Purging or compensatory measures include self-induced vomiting, diuretic and laxative abuse, and ipecac ingestion. Syrup of ipecac is a poison antidote that is available over-the-counter and it induces vomiting within half an hour of consumption. Bodily harm caused by bulimia is directly related to the type of purging used and the number of the times the cycle is repeated. Bulimics who induce vomiting daily for five years or more typically suffer from a condition called reverse peristalsis or involuntary intestinal contractions, which does not allow them to keep food down for more than a few minutes. Excessive vomiting also erodes dental enamel, creates potassium deficiency, and causes severe tearing and bleeding of the esophagus. Chronic laxative abuse causes issues with the colon and melanosis coli. While diuretic abuse results in dehydration and electrolyte imbalances. Bulimia also leads to amenorrhea in women with the same subsequent conditions listed above, i.e. bone loss. (Boskind, 2000)

The non-purging method is sometimes referred to as Exercise Bulimia. After a mass caloric intake, an individual with bulimia that does not engage in purging practices such as diuretic abuse, laxative abuse, and forced vomiting will utilize other measures to get rid of the weight. Typical non-purging methods include fasting or excessive exercise.

Eating disorders develop due to a myriad of reasons. Personal, cultural, and genetic influences all contribute to the development of an eating disorder. Women with eating disorders often express that their management of food is related to issues of control. They feel as though they cannot control what happens in the world around them, but what they do have control over is the food they ingest. More often than not, sufferers of eating disorders are self-proclaimed perfectionists and overachievers that typically did very well academically and in extracurricular activities prior to the development of an eating disorder. While eating disorders are prevalent among all socioeconomic and ethnic groups, eating disorders are more likely to develop in adolescents that are genetically predisposed to them or have low self-esteem in regard to their body image. Current research has found that certain neurotransmitters, such as serotonin and norepinephrine, act differently in the brains of those with eating disorders. (NAMI, 2011) Norepinephrine is a neurotransmitter that is released after a series of stressful events, it is in part related to the fight-or-flight reaction. Serotonin levels can affect mood and an imbalance in serotonin can lead to depression. Eating disorders are often coupled with other forms of mental illness such as depression, bipolar disorder, obsessive-compulsive disorder, substance dependency, and self-injurious behavior. (NAMI,2011)

Culture, in particular, widely influences what the general population sees as the aesthetic ideal for its members. This ideal changes overtime and varies from culture to culture. The ideal within Western media for women is one of extreme thinness. With the proliferation of American media and products, it has been purported that this extreme thinness ideal is spreading. In the documentary Beauty Mark(2008), Pat Mitchell, President and CEO of The Museums of Television and Radio in New York and Los Angeles and the International Media Council,claims that the introduction of Western television shows such as Baywatch in the nation of Bhutan led to the creation of a word for eating disorders in that country. Prior to the introduction of television in Bhutan in 1999, eating disorders were non-existent and therefore there was no reason to have a word describing them.

Over recent years, there has been an increase in the number of men suffering from eating disorders with as high as 10-15% of the male American population suffering from an eating disorder (NAMI, 2011). However, in regards to women, the American concept of femininity is directly linked to the development of an eating disorder. American society enforces the ideal that feminine beauty is associated with thinness. Such is evident through the images of thin models and actors that appear throughout all forms of media. According to the National Eating Disorder Association, the average US adolescent is exposed to over 5,260 commercials that send some sort of message as to what is attractive and what is not. From a young age, children are introduced to the concept that thin is attractive. One study found that children as young as age 2 were given a fat doll and a skinny doll, and most preferred the thin doll. The experiment was repeated with 5 year olds with 83% of this age group preferring the skinny dolls. Another experiment showed eight groups of children seven pictures of other children and the subjects were asked to who they would want to be friends with and who they would least likely want to be friends with. The seven pictures included images of an obese child, a child in a wheel chair, a child with one arm, a “normal” child, and a child with a facial disfigurement. Seven out of the eight groups chose the obese child as the one they would least likely want to be friends with. The social rejection and verbal abuse that overweight children suffer is one reason why this group is rather susceptible to developing an eating disorder later on in life (Schoenfielder, 1983). These messages suggest that attractiveness is associated with extreme thinness.

Since the 1950s, the women that appear in the media have been getting thinner and more waifish as men’s bodies have come to be associated with bulging muscles. Feminists postulate that women’s changing physical appearance in the media is connected to women’s rising power that stemmed from the Women’s Liberation Movement. In times where women are associated with their roles as mothers and nurturers, they appear more full-bodied, but in times when women are free from the constraints of their role as mother the notion of slim, boyishness becomes the norm (Boskind, 2000).

Aside from images of thin women in the media, there is also prominent emphasis on dieting in American culture. In a society where food is plentiful and femininity is measured by body type, it is difficult to find a healthy balance when the food that is most readily available is fattening and society expects one to be extremely thin. American consumers are bombarded with commercials for dieting programs and new exercising equipment, along with the plethora of articles and ads pertaining to weight loss in magazines. Women’s magazines are 10.5 times more likely to have advertisements and articles promoting weight loss than men’s magazines according to a study of mass media magazines(NEDA, 2005). In addition, articles about fitness in teen magazines are sending out the wrong message about why healthy exercise is important. There is more emphasis placed on exercising to look attractive and not exercising for the sake of maintaining health (NEDA, 2005). A study of 3,000 girls ages 12-21 found that reading teen magazines was significantly related to the development of an eating disorder (Wilson et al., 2006).

American adolescents, females in particular, are already bombarded on a daily basis with the message that thin is beautiful. Campaigns for more diverse body images have developed momentum over the past decade, but the sheer volume of media depicting extreme thinness is unparalleled. All one has to do is type “tips and tricks to lose weight” into any search engine and the first few pages will contain sites that tout pro-ana credo, unhealthy ways to obtain rapid weight loss, and hide weight loss methods that others may not approve of. With the vast number of people online, and the increasing amount of time that American adolescents spend online it is particularly concerning that pro-ED information can be so easily accessed.

Up to two thirds of adolescent girls seek health information online, and of nearly half of these searches pertain to ways to lose weight while a quarter is looking for information on eating disorders. There are three different kinds of websites available to Internet users that are trying to access information about eating disorders and they are: professional sites that include clinical information about eating disorders, pro-recovery sites that promote awareness about eating disorders, and pro-eating disorder sites which actively promote eating disorders as a lifestyle (Harper et al., 2008). Pro-recovery and professional sites simply cannot keep up with the growing number of pro-ED sites. From 2006 to 2007 alone, pro-eating disorder sites increased by 470% (Arresting Ana, 2008).

Research by Dr. Rebecca Peebles, co-author of the book Surfing for Illness(2008), shows that 90% of those who have accessed pro-ED sites have learned new weight loss or purging techniques. It has been documented that children as young as 12 are accessing pro-ED sites, and it is suspected that these websites are accessed by children even younger (Rouleau & Ranson, 2011). Many of the websites have disclaimers upon entering the home page announcing that the websites are for individuals that are 18 years old and up and that the sites take no responsibility for any distress caused by viewing the site. Yet, there is no way to enforce this age limit and search engines attempts to ban or censor pro-ED websites have failed miserably.

In 2008, French legislator Valerie Boyer, even attempted to pass a bill in Parliament that would have fought against the incitement of anorexia by imposing a two year prison sentence, and €30 to 45, 000 fines on the makers of pro-ED sites. The bill did not pass, however, and French senator Patricia Schillinger feels it would have done little to solve the problem of pro-ED sites anyway. The bill would criminalize the illness and as the legal and financial burden of the fines would most likely fall not onto the website creators, many of whom are under the age of 18, but onto their parents (Arresting Ana, 2008). In the United States, media attention in the early 2000s to pro-ED sites raised awareness within the medical community and among eating disorder awareness professional organizations. Groups such as the Anorexia Nervosa and Associated Disorders asked that pro-ED sites be shut down by major search engines such as Google and Yahoo. Sites were shut down, but new ones appeared almost instantaneously. (Rouleau & Ranson, 2010). The growing popularity of social networking and blogging sites such as Facebook and Tumblr have only increased the scope of pro-ED communities.

Throughout my research, I was unable to find scholarly information about the transitions of the pro-ana movement. Since the pro-ana movement is a relatively new extreme online community, only one article could be found that talked about the breadth of the definition of the pro-ED community. Giles (2006) purports that many believe that pro-eating disorder websites generally contain the same content and that was extremely supportive of eating disorders when in reality this is an over simplification and that pro-ED had a universal and coherent standpoint. Prior to this project, I even believed that the definition of pro-ana only meant one thing: to be in support of anorexia. However, the term pro-ana has different meanings depending on the user. Some say they are pro-ana to simply to refer to the fact that they are still suffering from anorexia while others take the more extremist definition. It is also important to note that there are different forms of thinspiration or thinspo. They all continue thin women, but some of the women look healthy even though they are thin while other thinspiration pictures depict women that are truly emaciated (See Appendix I). Once entering the sites, however, I encountered a description of the three different types of pro-eating disorder websites, the wide use of the definition of pro-ana, and that thinspiration also varied.