By Jacqueline Head BBC News Pro-anorexia websites offering tips on extreme dieting are nothing new, but their growth on social networking sites is a disturbing new twist and brings them within reach of a wider audience.
By Jacqueline Head BBC News Pro-anorexia websites offering tips on extreme dieting are nothing new, but their growth on social networking sites is a disturbing new twist and brings them within reach of a wider audience.
As a conversation opener, it's as blatant as it is troubling.
As a conversation opener, it's as blatant as it is troubling.
"What diet pills work best?" a young female user of a social networking site asks. The responses begin to trickle through from other members of the group which is an online meeting place for those people with anorexia.
"What diet pills work best?" a young female user of a social networking site asks. The responses begin to trickle through from other members of the group which is an online meeting place for those people with anorexia.
"They're all rubbish", says one, before another chips in with her favourite brand, which she says works well with "restricting" and "exercising". It could lose you seven pounds, she surmises.
"They're all rubbish," says one, before another chips in with her favourite brand, which she says works well with "restricting" and "exercising". It could lose you seven pounds, she surmises.
Another user goes on to ask for good tips "for when the hunger kicks in", a request met with a slew of suggestions.
Another user asks for good tips "for when the hunger kicks in", a request met with a slew of suggestions.
One of the Facebook groupsThe popularity of social networking websites has opened up a whole new world of interaction, but with it, darker trends are emerging. Groups which appear to extol grave eating disorders as a glamorous lifestyle choice are appearing on sites which claim tens of millions of active users.
One of the Facebook groupsThe popularity of social networking websites has opened up a whole new world of interaction, but with it, darker trends are emerging. Groups which appear to extol grave eating disorders as a glamorous lifestyle choice are appearing on sites which claim tens of millions of active users.
Members of such groups post pictures of painfully skinny girls for "thinspiration", compare dangerously low goal weights and measurements, and team up to "keep each other strong" in their quest to lose weight.
Members of such groups post pictures of painfully skinny girls for "thinspiration", compare dangerously low goal weights and measurements, and team up to "keep each other strong" in their quest to lose weight.
They swap stories on how they vomit until they cough blood, are often too weak to get out of bed and how they're scared family or friends will find out and force them into recovery.
They swap stories on how they vomit until they cough blood, are often too weak to get out of bed and how they're scared family or friends will find out and force them into recovery.
Moderated content
Moderated content
Such groups are known as "pro-ana" and "pro-mia" - that's pro-anorexia and pro-bulimia - websites.
Such groups are known as "pro-ana" and "pro-mia" - that's pro-anorexia and pro-bulimia.
Their existence on the net is nothing new. But their presence on social networking websites, which have rules against posting harmful content, raises the groups to a new respectability.
Their existence on the net is nothing new. But their presence on social networking websites, which have rules against posting harmful content, raises the groups to a new respectability.
Previously, people on such internet groups remained relatively anonymous, and the groups, being small, were sometimes hard to find. But on some social networking sites, users have real names and faces, and are more accessible than before.
Previously, people on such internet groups remained relatively anonymous, and the groups, being small, were sometimes hard to find. But on some social networking sites, users have real names and faces, and are more accessible than before.
Such groups can be found on many social networking sites, including the biggest:
Such groups can be found on many social networking sites, including the biggest:
One of the MySpace groups• MySpace includes groups such as Pro Ana Nation (with more than 1,000 members) which states, under its rules, "no people trying to recover, it ruins our motivation"; and Pro Extreme Dieting, which states: "we are here to support each other in our choices, even if they are to recover, or try to put on, or lose weight"
One of the MySpace groups• MySpace includes groups such as Pro Ana Nation (with more than 1,000 members) which states, under its rules, "no people trying to recover, it ruins our motivation"; and Pro Extreme Dieting, which states: "we are here to support each other in our choices, even if they are to recover, or try to put on, or lose weight"
• Facebook includes groups such as "Get thin or die trying", "Yes, I have an eating disorder. No, it's not your problem" and "Quod me nutrit me destruit" which translates as "what nourishes me destroys me"
• Facebook includes groups such as "Get thin or die trying", "Yes, I have an eating disorder. No, it's not your problem" and "Quod me nutrit me destruit" which translates as "what nourishes me destroys me"
While the groups are dominated by American users, they include many from the UK.
While the groups are dominated by American users, they include many from the UK.
Joining one "pro-ana" group can lead you to five more, and so on, opening up a world that, while posing as a means of support, more often tends to glamorise and advocate illnesses that can cause infertility, heart disease and death.
Joining one "pro-ana" group can lead you to five more, and so on, opening up a world that, while posing as a means of support, more often tends to glamorise and advocate illnesses that can cause infertility, heart disease and death.
Anorexia nervosa has the highest mortality rate of any psychiatric illness. Beat, the UK's Eating Disorder Association estimates that up to 20% of those who become seriously affected can die prematurely, and are at particularly high risk of suicide.
Anorexia nervosa has the highest mortality rate of any psychiatric illness. Beat, the UK's Eating Disorder Association estimates that up to 20% of those who become seriously affected can die prematurely, and are at particularly high risk of suicide.
Wasting away
Wasting away
Andrea Schneider, a 21-year-old from Columbia, Missouri, has struggled with anorexia since she was 16. In the past 18 months she says she has been admitted to hospital 15 times and had six feeding tubes.
Andrea Schneider, a 21-year-old from Columbia, Missouri, has struggled with anorexia since she was 16. In the past 18 months she says she has been admitted to hospital 15 times and had six feeding tubes.
'Thinner is the winner', that's a quote that we live by Andrea Schneider She used to log on to these groups to seek justification for what she was doing.
'Thinner is the winner', that's a quote that we live by Andrea Schneider She used to log on to these groups to seek justification for what she was doing.
"When you are actively in your eating disorder, you desperately want someone to understand, and a lot of time you find groups like the pro groups on Facebook that are supportive of you continuing your eating disorder," she says.
"When you are actively in your eating disorder, you desperately want someone to understand, and a lot of time you find groups like the pro groups on Facebook that are supportive of you continuing your eating disorder," she says.
"When you are in the middle of it and don't want to give it up, you cling to these sites that tell you what you are doing is OK. Recovery is hard, staying sick isn't, so it's easier to hide behind these sites claiming that you are making a lifestyle choice, rather than admitting that you are sick and trying to get better."
"When you are in the middle of it and don't want to give it up, you cling to these sites that tell you what you are doing is OK. Recovery is hard, staying sick isn't, so it's easier to hide behind these sites claiming that you are making a lifestyle choice, rather than admitting that you are sick and trying to get better."
As posted on FacebookMany girls in these groups, aged from about 15 to 30, claim their goal weight is below seven stones (45kg), and for some it is as low as 5 stones (32kg).
As posted on FacebookMany girls in these groups, aged from about 15 to 30, claim their goal weight is below seven stone (45kg), and for some it is as low as five stone (32kg).
"We always want to be the thinnest," Andrea says. "'Thinner is the winner', that's a quote that we live by."
"We always want to be the thinnest," Andrea says. "'Thinner is the winner', that's a quote that we live by."
"You will see girls talk on these sites about hitting their goal weight, but no matter what they say, their goal weight is never going to be low enough."
"You will see girls talk on these sites about hitting their goal weight, but no matter what they say, their goal weight is never going to be low enough."
Emma, a 17-year-old from New York, who still uses these groups, also believes they fuel anorexia.
Emma, a 17-year-old from New York who still uses these groups, also believes they fuel anorexia.
"Hearing girls your weight or smaller say they are fat makes you feel worthless. Ana tips can push you to take it too far and thinspirational pictures give you an unattainable goal."
"Hearing girls your weight or smaller say they are fat makes you feel worthless. Ana tips can push you to take it too far and thinspirational pictures give you an unattainable goal."
Never alone
Never alone
Dr John Morgan, a consultant psychiatrist St George's University Hospital, London, who specialises in eating disorders, says these groups run the risk of glamorising unhealthy behaviour.
Dr John Morgan, a consultant psychiatrist St George's University Hospital, London, who specialises in eating disorders, says these groups run the risk of glamorising unhealthy behaviour.
I have had some patients who have gone on pro ana websites and then gone on to seek treatment Dr John Morgan "It's become a lot more interactive which is more worrying. It much more rapidly reinforces the negative views these people have of themselves and provides an instant response to what they're looking for."
I have had some patients who have gone on pro ana websites and then gone on to seek treatment Dr John Morgan "It's become a lot more interactive, which is more worrying. It much more rapidly reinforces the negative views these people have of themselves and provides an instant response to what they're looking for."
But the impact of these groups is not entirely negative - and if properly regulated, they can be used for positive means. He says they can mirror group therapy, an important part of treatment, and help draw people out of their isolation.
But the impact of these groups is not entirely negative - and if properly regulated, they can be used for positive means. He says they can mirror group therapy, an important part of treatment, and help draw people out of their isolation.
"I have had some patients who have gone on pro-ana websites and then gone on to seek treatment," he says. "It's very daunting, and just having someone to hold your hand and explain the process can make a big difference."
"I have had some patients who have gone on pro-ana websites and then gone on to seek treatment," he says. "It's very daunting, and just having someone to hold your hand and explain the process can make a big difference."
Susan Ringwood, Beat's chief executive, says an eating disorder is a serious mental illness, not a fad, phase or lifestyle choice.
Susan Ringwood, Beat's chief executive, says an eating disorder is a serious mental illness, not a fad, phase or lifestyle choice.
"The sooner someone gets the help they need, the more likely they are to make a full recovery - yet some aspects of the pro ana world deliberately try to encourage people to avoid treatment.
"The sooner someone gets the help they need, the more likely they are to make a full recovery - yet some aspects of the pro-ana world deliberately try to encourage people to avoid treatment.
"But it is a complex issue, because what people who use these social networks often say is that they find an acceptance and sense of belonging that they don't get anywhere else. At Beat, we want to change the way we all think and talk about eating disorders, and that means showing we can provide that acceptance and understanding, so that a pro ana group isn't the only refuge there is."
"But it is a complex issue, because what people who use these social networks often say is that they find an acceptance and sense of belonging that they don't get anywhere else. At Beat, we want to change the way we all think and talk about eating disorders, and that means showing we can provide that acceptance and understanding, so that a pro ana group isn't the only refuge there is."
Fellow feeling
Fellow feeling
Anastasia, a 19-year-old student in London, suffers from anorexia and bulimia and uses social networking groups for support.
Anastasia, a 19-year-old student in London, suffers from anorexia and bulimia and uses social networking groups for support.
I joined groups to get ana tips and to have a place to share my feelings, rather than judged Emma "People around me support me, but I can't tell them everything. In these groups I can ask questions and talk about how I feel to people I know went through the same issues and feelings."
I joined groups to get ana tips and to have a place to share my feelings, rather than judged Emma "People around me support me, but I can't tell them everything. In these groups I can ask questions and talk about how I feel to people I know went through the same issues and feelings."
For Emma, social networking sites are her only option for support.
For Emma, social networking sites are her only option for support.
"I would be found out if pro ana sites showed up on the history of my computer. These groups really connect girls from all over and create true friendships. I myself originally set up my fake account and joined groups to get ana tips and to have a place to share my feelings and be understood, rather than judged."
"I would be found out if pro-ana sites showed up on the history of my computer. These groups really connect girls from all over and create true friendships. I myself originally set up my fake account and joined groups to get ana tips and to have a place to share my feelings and be understood, rather than judged."
A spokesman for MySpace says it can be "very tricky" to distinguish between support groups for users who are suffering from eating disorders, and groups that might be termed as pro anorexia or bulimia.
A spokesman for MySpace says it can be "very tricky" to distinguish between support groups for users who are suffering from eating disorders, and groups that might be termed as pro anorexia or bulimia.
"Rather than censor these groups, we are working to create partnerships with organisations that provide resources and advice to people suffering from such problems, and we will target those groups with messages of support."
"Rather than censor these groups, we are working to create partnerships with organisations that provide resources and advice to people suffering from such problems, and we will target those groups with messages of support."
Facebook failed to respond to our questions.
Facebook failed to respond to our questions.
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Is this really dissimilar from the "pro fat" groups that exist, Big and Proud and all that? Perhaps people should be left to make their own choices instead of being called mentally deranged. I'm of the opinion that if you tell someone they are suffering from a mental illness enough, they will believe it. Let these people destroy their bodies - it's called "choice".Vaughan Jones, Nuneaton, UK
As a sufferer of bulimia I am slightly concerned that you have named the specific groups found on Facebook and My Space. I am in recovery so I'm not interested but there may be people looking on here who may go on to find them from the names you have provided. So-called pro-ana groups will always find places to meet on the internet, irrespective of what protective mechanisms are put in place.Rachel Welch, Norfolk
The problem is not with the social networking sites, the problem is with the people using them. There is nothing new with like-minded people getting together, be it in book clubs, the air cadets or a pro anorexia group in a social networking site. If teenage girls want to remove themselves from the genepool. Then we either accept that and we let them get on with it or we label them insane and take away their rights.If we accept that they have the right to kill theselves, then they have the right to have their groups on social network sites.Alan Addison, Glasgow, UK
Is this really dissimilar from the "pro-fat" groups that exist, Big and Proud and all that? Perhaps people should be left to make their own choices instead of being called mentally deranged. I'm of the opinion that if you tell someone they are suffering from a mental illness enough, they will believe it. Let these people destroy their bodies - it's called "choice".Vaughan Jones, Nuneaton, UK
The problem is not with the social networking sites, the problem is with the people using them. There is nothing new with like-minded people getting together, be it in book clubs, the air cadets or a pro anorexia group in a social networking site. We either accept that and we let them get on with it, or we label them insane and take away their rights. If we accept that they have the right to kill themselves, then they have the right to have their groups on social network sites.Alan Addison, Glasgow, UK
