1

lull reporL


vlttoolly Aootexlc Wheres the harm?
A research sLudy on Lhe rlsks of pro-anorexla webslLes

28
Lh
november 2012









ur. Lmma 8ond
unlverslLy Campus Suffolk
School of Applled Soclal Sclences
WaLerfronL 8ulldlng
lpswlch
Suffolk
l4 1C!
1el: 01473 338000

www.ucs.ac.uk

8eglsLered Company number: 03078498

1hls reporL ls avallable Lo download free of charge from www.ucs.ac.uk/vlrLuallyanorexlc


2


1bls tepott telofotces tbe lmpottooce of eJocotloq people to be sofe, cooflJeot ooJ competeot
osets of Jlqltol tecbooloqles. lo pottlcolot lt blqbllqbts bow cbolleoqloq, bot vltol, tbls tosk ls to
eosote we best soppott tbe slqolflcoot oombet of people wltb eotloq JlsotJers. Its easy to
blqbllqbt tbe beoeflts of oolloe commooltles fot soppottloq people tbtooqb sboteJ expetleoces
when looking at communities such as Beatbullyings Cybermentors
(bttp.//www.cybetmeotots.otq.ok/) or Youthnets TheSite (bttp.//www.tbeslte.otq/) bot tbls
tepott blqbllqbts bow oolloe commooltles coo telofotce messoqes ooJ bebovloots wblcb coo
locteose tbe tlsks foceJ by tbose occessloq tbem. 5oppottloq people to become ctltlcol osets of
digital technology is central to the work of Nominet Trust and its a responsibility that lies across
sectots ooJ ptofessloool ooJ fomlly toles. As pott of tbls, soppottloq people to Jevelop tbelt
ctltlcol ooJetstooJloq of, ooJ bebovloots wltblo soclol oetwotks ls vltol.

1bls tepott follows o comptebeoslve stoJy loto o cbolleoqloq oteo ooJ l bope tbot ls osefol to
eosote we coo bollJ tbe most opptoptlote Jlqltol, ooJ ooo-Jlqltol soppott fot people wltb eotloq
JlsotJets.

Dan Sutch
nead of Deve|opment kesearch
nomlneL 1rusL

Lxecut|ve summary
1hls research by ur. Lmma 8ond aL uCS, funded by nomlneL 1rusL, lnvesLlgaLed Lhe rlsks from Lhe
lncreaslng number of pro-anorexla webslLes onllne. 1he sLudy examlned 126 pro-eaLlng dlsorder
webslLes and onllne communlLles and found LhaL Lhe slLes promoLe a dlsordered vlew of
perfecLlon ln relaLlon Lo body lmage whlch normallses an ulLraLhln/emaclaLed body. 1here ls ofLen
exLreme or dangerous dleLlng advlce glven whlch promoLe harmful behavlours. 1he slLes relnforce
an eaLlng dlsordered self-ldenLlLy and bullylng ls frequenL. 1here ls an lncreaslng avallablllLy of
pro-eaLlng dlsorder forums and blogs buL Lhe naLure of Lhe slLes varles accordlng Lo Lhe Lype of
onllne space. 1he rlsks vary accordlng Lo Lhe Lype of conLenL and Lhe frequency of vlslLs and young
people who have low levels of self-esLeem or are lacklng ln self-confldence are especlally
vulnerable. lor people wlLh an eaLlng dlsorder Lhere ls a problemaLlc relaLlonshlp beLween feellng
lsolaLed from famlly and frlends and flndlng supporL ln onllne envlronmenLs whlch makes
LreaLmenL and recovery complex. 1he research concludes LhaL healLh professlonals, educaLors and
parenLs need Lo be aware of ro-Anorexla slLes and Lhe rlsks Lhey may pose buL lL ls lmporLanL noL
Lo unnecessarlly adverLlse Lhelr exlsLence Lo chlldren and young people. LducaLlonal sLraLegles
almed aL chlldren and young people should emphaslse Lhe lmporLance of crlLlcal Lhlnklng around
vlsual lmages ln relaLlon Lo Lhe wlder conLexL of harmful conLenL onllne.
3



















1bls ls o vety osefol stoJy of pto-ooo websltes belploq to ptoflle tbelt llkely osets ooJ tbe tlsks
tbot tbese sltes pose to people tecovetloq ftom eotloq JlsotJets. 1be tepott ls o tbotooqb stoJy
of tbe pto-ooo pbeoomeooo, qlvloq teoJets oo loslqbt loto tbe mloJset of some oootexlcs ooJ
highlighting the risks that such websites pose.

!"#$ &'()*+
,-*)./"* "0 12)*'/-"$3
!"#$


"1bls tepott sbeJs llqbt by ptovlJloq o soopsbot loto tbe wotlJ of pto-ooo ooJ pto-u sltes
ooJ oolloe eovltoomeots, wblcb coopleJ wltb o tevlew of otbet teseotcb lo tbls oteo
ptovlJes o tlmely ooJ osefol tool fot pollcy mokets, beoltb ptofessloools ooJ eJocotots.
1bls ls o cbolleoqloq oteo to teseotcb, bot tbe tesolts coo be voty volooble ooJ ot cbllJoet
we wlll tevlew tbls ooJ look to Jevelop lJeos oboot bow to oJJtess tbls lo oot eJocotloo
ooJ owoteoess wotk ooJ lofotm tbe pollcy of otbets.

lt ls ctoclol tbot we eJocote ooJ empowet beoltb ptofessloools to tecoqolse ooJ tespooJ to
tbese oolloe tlsks ooJ bebovloots, pottlcolotly os o slqolflcoot oombet of sltes ote
JevelopeJ by ooJet-18s wltb eotloq JlsotJets ooJ tbe popolotlty of oset-qeoetoteJ lmoqes
moy bove o looq tetm lmpoct oo tbose wbo oplooJ tbls cooteot. As blqbllqbteJ by tbe u
klJs Oolloe ptoject, 10X of 11-16s boJ beeo exposeJ to pto-eotloq JlsotJet cooteot, wblcb
Jemoosttotes tbe oeeJ to Jevelop oolloe tesllleoce lo oll yoooq people ooJ fostet o ctltlcol
opptoocb to vlsool lmoqes".


4-55 6'*7$)*
8#-)0 9:).;/-() 100-.)*
&'()*+"$ ,+$"-+#$(.+#)


4


1ab|e of contents:

1. lnLroducLlon and conLexL

3
2. MeLhodology
2.1. LlLeraLure revlew
2.2. LLhlcal conslderaLlons
2.3. 8eporLlng guldellnes
2.4. 8esearchlng onllne envlronmenLs
2.3. Sample selecLlon
2.6. Acronyms used ln Lhe reporL

8
8
12
13
14
13
18
3. undersLandlng eaLlng dlsorders and pro-Lu

19
4. llndlngs

21
3. key Lhemes:
3.1. erfecLlon
3.2. erformlng
3.3. roLecLlon
3.4. aradoxes

23
23
31
36
39
6. undersLandlng rlsk Concluslons

40
7. 8ecommendaLlons
7.1. LducaLlon and awareness ralslng
7.2.undersLandlng rlsk and harm ln relaLlon Lo
nnnnn young people
7.3. Medla responslblllLy
7.4. ueveloplng a culLure of respecL
7.3. Warnlngs
7.6. losLerlng crlLlcal debaLe
42
42
43

43
44
44
43
3


1. Introduct|on and Context
1.1. This document outlines the main findings from the research study Virtually anorexic: Wheres
the harm? which Dr. Emma Bond, Senior Lecturer in the department of Applled Soclal
Sclences aL unlverslLy Campus Suffolk underLook beLween !anuary !une 2012 ln parLnershlp
wlLh 8eaL
1
and ChlldneL lnLernaLlonal.
2
1he sLudy was funded by nomlneL 1rusL.
3
1he research
almed Lo galn knowledge and undersLandlng of pro-anorexla slLes and onllne communlLles
and Lo provlde a revlew of Lhe rlsks ln relation to young peoples use of pro-anorexla (pro-ana)
and pro-eaLlng dlsorder (pro-Lu) slLes.

1.2. 1hls sLudy ls slgnlflcanL as healLh relaLed slLes and dlscusslon forums enable people all over
Lhe world Lo communlcaLe on a parLlcular Loplc or shared lnLeresL.
4
Powever, Lhere ls a lack of
evldence-based onllne healLh lnformaLlon relaLed Lo eaLlng dlsorders whlch places
adolescenLs and Lhelr famllles aL rlsk of obLalnlng lnadequaLe lnformaLlon regardlng Lhe
cllnlcal characLerlsLlcs and LreaLmenL opLlons avallable.
3


1.3. 1hls sLudy does noL only focus on rlsks Lo adolescenLs. Accordlng Lo Mlnd (Lhe leadlng menLal
healLh charlLy for Lngland and Wales), 1 ln 100 women aged beLween 13 and 30 ln Lhe uk
suffer from anorexla and recenL reporLs show some glrls as young as flve years of age have
welghL concerns, and Lhlnk abouL golng on a dleL. Anorexla nervosa (An) ls mosL llkely Lo
sLrlke durlng Lhe mld-Leenage years and lL affecLs approxlmaLely 1 ln 130 flfLeen-year-old
females, and 1 ln 1000 flfLeen-year-old males.
6


1.4. 1here are lncreaslng concerns over Lhe number and avallablllLy of pro-ana and pro-Lu slLes on
Lhe lnLerneL yeL llLLle ls known abouL why people use Lhem, whaL Lhey use Lhem for and
wheLher or noL Lhey are conLrlbuLlng Lo elLher Lhe anorexlc condlLlon or Lhe pro-ana
phenomenon. lL ls well acknowledged LhaL people use new medla Lechnologles for boLh rlsk
managemenL and rlsk-Laklng behavlours Lo achleve ldenLlLy as lndlvlduals and as members of
culLural groups ln boLh offllne and onllne envlronmenLs.

1.3. WhllsL Lhere have been oLher sLudles whlch conslder pro-Lu webslLes, Lhls sLudy looked
speclflcally aL rlsks ln relaLlon Lo Lhese slLes. lL dld noL, however, seek Lo adopL a medlcal
perspecLlve ln relaLlon Lo boLh undersLandlng eaLlng dlsorders (Lus) and Lhe rlsks assoclaLed
wlLh Lhem. uue Lo eLhlcal conslderaLlons Lhls research consldered Lhe avallablllLy and conLenL
of onllne pro-Lu webslLes, communlLles and Weblogs publlcally avallable. lL dld noL
endeavour Lo dlscuss Lhe experlence of uslng Lhese slLes nor belng parL of Lhe Lu communlLy
onllne. lL ls argued LhaL lL ls essenLlal Lo galn a deeper undersLandlng of why people use Lhese
slLes, how Lhey use Lhem and Lhelr LhoughLs and feellngs abouL "#$%& 1hls ls one of Lhe
recommendaLlons of Lhe reporL and some suggesLlons for furLher research are made.


1 8eaL provldes helpllnes, onllne supporL and a neLwork of uk-wlde self-help groups Lo help adulLs and young people ln Lhe uk beaL Lhelr eaLlng dlsorders see hLLp://www.b-eaL.co.uk/
2 ChlldneL lnLernaLlonal ls a non-proflL organlzation working with others to help make the InterneL a greaL and safe place for children see http://www.childnet.com/
3 Nominet Trust was established in January 2008 by Nominet, one of the worlds largest Internet registries, which maintains the .uk reglsLer of domaln names. As part of Nominets publlc purpose, nomlneL 1rusL was seL
up Lo fund lnLerneL-based pro[ecLs LhaL make a poslLlve dlfference Lo Lhe llves of dlsadvanLaged and vulnerable people see hLLp://www.nomlneLLrusL.org.uk/
4 1lerney, S. (2006) 1he uangers and uraw of Cnllne CommunlcaLlon: ro-Anorexla WebslLes and Lhelr lmpllcaLlons for users, racLlLloners, and 8esearchers. ln otloq ulsotJets 14. 181-190.

3 SmlLh, A. 1. and McCowan, k. A. (2011: 36) CuallLy of LaLlng ulsorders WebslLes: WhaL AdolescenLs and 1helr lamllles need Lo know. ln Iootool of cbllJ ooJ AJolesceot lsycblottlc Notsloq vol. 24 ll JJ-J7.

6 1he 8oyal College of sychlaLrlsLs [onllne] hLLp://www.rcpsych.ac.uk/menLalhealLhlnfoforall/problems/eaLlngdlsorders/eaLlngdlsorders.aspx
6

1.6. 1hls research pro[ecL ls an lnLerneL-based exploraLory sLudy whlch almed Lo lmprove
knowledge and undersLandlng of pro-ana webslLes and onllne communlLles. lL consldered
percepLlons of rlsk from a varleLy of perspecLlves and noLlons of self-ldenLlLy ln relaLlon Lo
pro-ana onllne envlronmenLs. 1he research examlned how Lhe slLes offer Llps and advlce,
supporL and oLher lnformaLlon and an embodied soclal space for people wlLh eaLlng dlorders.
1.7. 1he research gaLhered deLalled emplrlcal evldence uslng exlsLlng llLeraLure and collecLed daLa
onllne. 8oLh quanLlLaLlve and quallLaLlve daLa were analysed, lncludlng LexL and lmages
gaLhered from selecLed, publlcally avallable pro-ana webslLes, blogs and onllne forums. 1he
relaLlonshlp beLween Lhe users perceptions of risk as discussed online, self-ldenLlLy and
onllne envlronmenLs was examlned ln order Lo galn knowledge and undersLandlng of Lhe
range, uses and conLenL of Lhese slLes.

1.8. uue Lo Lhe eLhlcal complexlLles of researchlng onllne envlronmenLs and reporLlng flndlngs
speclflcally ln relaLlon Lo Lus (as ouLllned above), for Lhe purposes of Lhls research only
webspaces whlch were noL password proLecLed were lncluded ln Lhe sLudy.

1.9. An ob[ecLlve of Lhls sLudy was Lo conslder a research framework for an ln-depLh parLlclpanL-
cenLred vlrLual eLhnography for researchlng pro-ana envlronmenLs onllne whlch Lakes lnLo
accounL Lhe compllcaLed eLhlcal lssues ralsed by research of Lhls Lype and ln Lhls sub[ecL area.
1hls ls one of Lhe recommendaLlons of Lhls reporL. lurLher research would faclllLaLe a more
deLalled undersLandlng of Lhe vlews and experlences of Lhe onllne Lu communlLy and Lhelr
famllles and Lhe adopLlon of parLlclpanL cenLred ln-depLh analysls of Lhe soclal phenomena
descrlbed ln Lhls reporL ls a recommendaLlon of Lhls reporL. A deLalled emanclpaLory research
pro[ecL wlLh Lhls oppressed and ofLen sLlgmaLlsed group would access knowledge LhaL Lhe
sLudy presenLed here ls unable Lo offer and allow prevlously excluded volces Lo be heard.

1.10. AlLhough pro-ana slLes are dlfferenL from oLher soclal neLworklng slLes such as lacebook, Lhe
dlscusslon of Lhe body and the self ln vlrLual envlronmenLs can also poLenLlally have dlsLlncL
poslLlve lmpllcaLlons ln relaLlon Lo wellbelng, peer neLworks and ldenLlfy formaLlon. WhllsL
Lhere are rlsks and dangers relaLed Lo pro-Lu webslLes whlch Lhls reporL hlghllghLs lL should
neverLheless be noLed LhaL LhaL Lhese envlronmenLs also offer poLenLlal beneflLs Lo people
wlLh Lus and Lhelr famllles LhaL may be drawn upon and adopLed ln Lhe consLrucLlon of
poslLlve vlrLual envlronmenLs by pro-recovery organlzaLlons.

1.11. 1he values and prlnclples of hlgh quallLy soclal research onllne have underplnned Lhls sLudy
LhroughouL and Lhls research has been conducLed ln llne wlLh Lhe prlnclples seL ouL by Lhe
Slngapore SLaLemenL on 8esearch lnLegrlLy
7
and ls reporLed ln a way LhaL ls respecLful Lo Lhe
communlLy lL has lnvesLlgaLed and conslders Lhe reporLlng guldellnes ouLllned by 8eaL.
8


1.12. lunded by nomlneL 1rusL and ln parLnershlp wlLh 8eaL and ChlldneL lnLernaLlonal, Lhls sLudy
alms Lo ralse awareness of Lhe poLenLlal rlsks assoclaLed wlLh pro-ana slLes and onllne
envlronmenLs for vulnerable young people Lhrough wlde-ranglng dlssemlnaLlon acLlvlLles and
furLher dlscusslons wlLh academlcs, pollcymakers and pracLlLloners.

1.13. Cverall Lhe sLudy provldes a comprehenslve and deLalled accounL of onllne pro-ana
envlronmenLs LhaL are openly accesslble Lhrough a baslc search englne such as Coogle. 1he
daLa obLalned from Lhe research deLalls Lhe conLenL of webslLes and onllne forums and
lncludes boLh quanLlLaLlve and quallLaLlve verbaLlm daLa and assoclaLed documenLs such as
phoLographs, lmages and vldeo whlch were sysLemaLlcally analysed lnLo caLegorles

7

Slngapore SLaLemenL on 8esearch lnLegrlLy avallable Lo download from: hLLp://www.slngaporesLaLemenL.org/

8

8eaL [onllne]MeJlo tepottloq qolJelloes avallable from hLLp://www.b-eaL.co.uk/abouL-beaL/medla-cenLre/medla-guldellnes/

7

erfecLlon, erformance, roLecLlon and aradoxes. 1he caLegorles are dlscussed ln Lhls
reporL ln order Lo presenL Lhe range of ldenLlfled rlsks ln relaLlon Lo Lhese slLes and onllne
forums. 1hese flndlngs are consldered ln relaLlon Lo Lhe exlsLlng llLeraLure on eaLlng
dlsordered people and onllne envlronmenLs.
8


2. Methodo|ogy



2.1. L|terature rev|ew

1he research commenced wlLh a Lhorough llLeraLure search uslng academlc research daLabases. 1he
revlew consldered currenL professlonal and academlc llLeraLure from a varleLy of perspecLlves
(medlcal, psychologlcal, soclologlcal, femlnlsL and medla/culLural) on pro-Lu webslLes and ldenLlfled
Lhe key lssues Lo daLe. 1he research Lhus bullL upon exlsLlng concepLual frameworks of anorexla and
pro-anorexla ln order Lo analyse Lhe conLenL of Lhe webslLes and onllne envlronmenLs ln relaLlon Lo
whaL ls already known abouL Lhe condlLlon and Lhe pro-ana/Lu communlLy onllne.
9

10

key |ssues |dent|f|ed from the ||terature rev|ew:

11

12

2.2. Lth|ca| cons|derat|ons

2.2.1. AlLhough Lhere ls no slngle comprehenslve eLhlcal framework for underLaklng Lhls Lype of
research Lhe sLudy used boLh Lhe 8rlLlsh Soclologlcal AssoclaLlon (8SA) and Lhe 8rlLlsh
sychologlcal Socletys (BPS) guldellnes for onllne research ln order Lo ensure LhaL eLhlcal
sLandards were adhered Lo and eLhlcal lssues consldered LhroughouL. 1he pro[ecL was sub[ecL
Lo full eLhlcal approval from Lhe uCS LLhlcs commlLLee and complled wlLh uCS eLhlcal
guldellnes. 1he research sLudy was noL lnLeracLlve (l.e. lL dld noL make conLacL wlLh users nor
make any posLs). 1hls was a small scale exploraLory sLudy and was conducLed uslng conLenL
analysls only.

2.2.2. ln Lhls research reporL careful conslderaLlons have been made wlLh regard Lo presenLlng Lhe
daLa. Accordlng Lo Lhe 8S:

Researchers should avoid using quotes that are traceable to an individuals posting via a search engine
unless Lhe parLlclpanL has fully undersLood and consenLed Lo Lhls. lnsLead, Lhey could conslder Lhe use
of composite characters for analysis, and the paraphrasing of quotes, if this is consistent with the
research deslgn. Speclflcally, Lhe address of Lhe webslLe or dlscusslon forum from whlch any daLa ls
gaLhered should noL be publlshed alongslde any analysls of communlcaLlon sourced from LhaL same
slLe. 1he pseudonyms used by posLers Lo communlcaLlon forums should be LreaLed wlLh Lhe same
ethical respect as a researcher would treat a persons real name.
9


lssues of confldenLlallLy and anonymlLy have, Lherefore, applled LhroughouL. names of
webslLes and conLrlbuLors are noL lncluded ln Lhls reporL all dlrecL quoLes and screen casLs
from webslLes and chaL rooms have been puL Lhrough Wordle.
10


2.2.3. lurLhermore, 1he 8S guldellnes
11
state that: In many currenL lnLerneL MedlaLed 8esearch
(lM8) research paradlgms, Lhe parLlclpanL ls llkely Lo be unldenLlflable and unconLacLable by
Lhe researcher. ln plannlng research, Lherefore, lnvesLlgaLors musL conslder wheLher Lhey are
llkely Lo encounLer problems, and whaL course of action will be adopted if they do. 1o Lhls
end lf Lhe research had ldenLlfled a concern ln relaLlon Lo a young persons (under 16)
wellbelng (for example a posL sLaLlng LhaL Lhey felL sulcldal) Lhe approprlaLe organlzaLlon e.g.
CLC would have been conLacLed wlLh Lhe deLalls of Lhe posLlng Lo be approprlaLely
lnvesLlgaLed.

2.2.4. 1he 8S
12
suggesLs LhaL unless consenL has been soughL, observaLlon of publlc behavlour
needs to take place only where people would reasonably expecL Lo be observed by sLrangers.
ln order Lo comply wlLh Lhls no password proLecLed webslLes or forums were lncluded ln Lhls
sLudy, only Lhose LhaL were easlly accesslble and ln Lhe publlc domaln were accessed.

2.2.3. lL ls, however, noLeworLhy LhaL Lhe revlew of Lhe llLeraLure revealed somewhaL conLradlcLory
pracLlce ln relaLlon Lo Lhe eLhlcal conslderaLlons assoclaLed wlLh onllne research of pro-Lu
webslLes. Some sLudles have underLaken coverL observaLlonal and lnLeracLlve eLhnographlc
research ln pro-ana communlLles whllsL oLhers documenL LhaL Lhey merely lurked. Some
prevlous research has lncluded password proLecLed communlLles, chaL rooms and forums
whllsL oLher research endeavours have declared Lhls lnapproprlaLe and eLhlcally unaccepLable.
ulfferenL research approaches enLall dlfferlng eLhlcal vlewpolnLs. 1he 8S suggesL LhaL Lhere
are Len lssues whlch should be fundamenLal conslderaLlons when researchlng ln onllne

9 8rlLlsh sychologlcal SocleLy (2007) cooJoctloq keseotcb oo tbe lotetoet. ColJelloes fot tblcol ltoctlce lo lsycboloqlcol keseotcb Oolloe [onllne] avallable from hLLp://www.bps.org.uk/publlcaLlons/pollcy-
guldellnes/research-guldellnes-pollcy-documenLs/research-guldellnes-pollcy-documenLs/
10 Wordle is an online tool for generating word clouds from text that you provide. The clouds give greater prominence to words that appear more frequently ln Lhe source

11

8rlLlsh sychologlcal SocleLy op.clL.

12

lbld.

13

environments: verifying identity; public/private space; informed consent; levels of control;
wlLhdrawal, debrleflng, decepLlon, monlLorlng, proLecLlon of parLlclpanLs and researchers and
daLa proLecLlon.
13

2.3. keport|ng gu|de||nes

2.3.1. Words and plcLures maLLer and Lhere are some Lerms, phrases and lmages LhaL can
lnadverLenLly adversely lmpacL on someone affecLed by an eaLlng dlsorder. AlLhough an
eaLlng dlsorder cannoL develop Lhrough copylng whaL anoLher person does a person wlLh an
eaLlng dlsorder can be lnfluenced by Lhe dlsordered behavlour of oLhers whlch can be
parLlcularly dangerous. no lmages (oLher Lhan one a slmple search on Coogle lmages) have,
Lherefore, been lncluded ln Lhls reporL.

2.3.2. CompeLlLlveness, perfecLlonlsm, conLrol and low self-esLeem comprlse Lhe key personallLy
LralLs LhaL ralse Lhe rlsk for lndlvlduals wlLh eaLlng dlsorders. eople wlLh eaLlng dlsorders
[udge Lhemselves very harshly and are consLanLly comparlng Lhemselves negaLlvely wlLh
oLhers. 1hey Lyplcally feel Lhey are noL lll enough Lo deserve LreaLmenL and help even when
Lhey are very serlously lll lndeed. 1helr dangerously dlsLorLed body lmage can convlnce Lhem
Lhey are grossly overwelghL when ln reallLy Lhey are emaclaLed. 1hls dlsLorLlon only affecLs
Lhelr percepLlon of Lhelr own body Lhey are able Lo accuraLely [udge when oLhers are
underwelghL or lll. eople wlLh eaLlng dlsorders speak about being triggered how Lhelr
eaLlng dlsorder behavlour and negaLlve menLal sLaLe can be sLlmulaLed, encouraged or
relnforced by cerLaln words, lmages or slLuaLlons. 1reaLmenL and Lherapy can help people Lo
ldenLlfy, recognlse and manage Lhese Lrlggers, buL Lhey remaln a hlgh rlsk Lo Lhe lndlvldual.
8eaL provldes speclflc advlce and guldance on Lhe reporLlng of LaLlng ulsorders. 1hls reporL
follows Lhls guldance and any press coverage of Lhls research ls requesLed Lo follow Lhe
guldellnes seL ouL by 8eaL avallable Lo download from 8eaL hLLp://www.b-eaL.co.uk/abouL-
beaL/medla-cenLre/medla-guldellnes/
14
.

13

lbld.
14

8eaL [onllne]MeJlo tepottloq qolJelloes avallable from hLLp://www.b-eaL.co.uk/abouL-beaL/medla-cenLre/medla-guldellnes/

14



2.3.3. Lveryone ls dlfferenL, buL Lhere are some common feaLures of Lhe medla reporLlng of eaLlng
dlsorders LhaL people affecLed would flnd problemaLlc:

Spec|f|c we|ghts

Any menLlon of Lhe lowesL welghL a person aLLalned ls
unhelpful. 1he compeLlLlve naLure of eaLlng dlsordered
Lhlnklng would mean such a number would become a
LargeL Lo alm for. 1he self-crlLlcal aspecL would make
someone judge themselves harshly if they didnt get that
low they cant have been really ill, or not a proper
anorexlc lf Lhelr own welghL was hlgher Lhan LhaL
reporLed ln Lhe medla.
Amounts eaten

Slmllarly, menLlon of speclflcally small amounLs eaLen e.g.
lived on half an apple a day would act as an
encouragemenL Lo resLrlcL or purge.
Images

lmages, especlally phoLographs of cerLaln emaclaLed body
parLs are Lrlggerlng rlbcages, concave sLomachs, collar
bones, sLernums and splnes. 1ops of arms LhaL are shown
as Lhe same clrcumference as wrlsLs, or Lhlghs Lhe slze of
knees are also unhelpful.

2.3.4. More general polnLs Lo conslder avoldlng are lnaccuracles such as referrlng Lo an eaLlng
dlsorder as the slimmers disease or as a phase, fad, or some celebrlLy copycaL. Calllng
someone an anorexia or bulimia victim is not helpful, neither is adding orexia as a suffix to
creaLe a Lrlvlal assoclaLlon. Examples are brideorexia for women dieting Lo flL a parLlcular
wedding dress or tanorexia for someone constantly using sunbeds because they believe they
look Lhlnner wlLh a Lanned skln. Referring to someone as flirting with an eating disorder or
having a touch of anorexia is unhelpful as it can Lrlvlallse Lhe condlLlon.

2.4. kesearch|ng Cn||ne Lnv|ronments

1hls sLudy uses text to refer to data derived from words and/or images which have
become recorded without the intervention of a researcher and Lhe advanLages of collecLlng
daLa ln Lhls way are ouLllned below
13
:


8lchness Close analysls of wrlLLen LexLs reveals presenLaLlonal subLleLles and
skllls
8elevance and
effecL
1exLs lnfluence how we see Lhe world and Lhe people ln lL and how
we acL Lhlnk of adverLlsemenLs and Cvs!
naLurally
occurrlng
1exLs documenL whaL parLlclpanLs are acLually dolng ln Lhe world
wlLhouL belng dependenL on belng asked by researchers
AvallablllLy 1exLs are usually readlly accesslble and noL always dependenL on
access or eLhlcal consLralnLs. 8ecause Lhey may be qulckly gaLhered,
Lhey encourage us Lo begln early daLa analysls


13 See Sllverman, u. (2011: 229-230) lotetptetloq Ooolltotlve Joto (4Lh Ldn.) London: Sage
13

2.4.1. 1hls sLudy does noL clalm LhaL Lhe daLa drawn from Lhe conLenL of Lhese onllne spaces ls a
Lrue deplcLlon of peoples lives ([usL as lnLervlew daLa/observaLlons and quesLlonnalre
responses do noL represenL Lhe reallLy of llved experlences) buL LhaL Lhese onllne spaces do
offer rich examples of naLurally occurrlng daLa whlch vlvldly represenL how people represenL
Lhelr acLlvlLles and experlences.
16


2.4.2. 1he flndlngs are presenLed as a Lrue record of evenLs ln order Lo undersLand Lhe pro-ana
onllne culLure and communlLy. 1he sLudy achleved numerlcal ouLcomes Lhrough analyLlcal
caLegorles and narraLlve analysls Lo presenL Lhe sLorles found Lhere.
17
lurLhermore, Lhe
careful analysls of lmages, whlch are cenLral Lo Lhe vlsual ln posL modernlLy
18
,

used pre-
exlsLlng vlsual represenLaLlons.
19


2.4.3. Culture became a crucial means by which many social scientists understood social processes,
soclal ldenLlLles, and soclal change and confllcL.
20
1hls analysls adopLs a culLural approach ln
LhaL lL conslders soclal processes, soclal ldenLlLles, soclal changes (ln relaLlon Lo onllne
envlronmenLs) and confllcL.
2.S. Samp|e se|ect|on
2.3.1. A LoLal of 126 webslLes and blogs were consldered ln Lhe research sLudy. All Lhe slLes were
non-password proLecLed and found Lhrough a slmple sLraLegy of Lyplng pro-anorexla; pro-
ana or pro-ED lnLo Coogle or Lhrough a llnk from a slLe found ln Lhe orlglnal Coogle search.
1he raLlonale behlnd Lhe sampllng sLraLegy was Lo flnd slLes avallable Lhrough a baslc search
and, Lherefore, easlly accesslble Lo young people wlLhouL requlrlng Lechnlcal experLlse (raLher
Lhan by uslng a more Lechnlcally complex rouLe).

2.3.2. lncluslon and excluslon crlLerla were lnlLlally employed ln order Lo exclude slLes whlch were
pro-recovery (lncludlng pro-recovery slLes noL run by professlonal/medlcal organlzaLlons).
Cnly Lhose slLes LhaL were openly anLl-recovery and pro-Lu were lncluded. lor eLhlcal reasons
any slLes whlch requlred access vla a password were also excluded. Some slLes dld, however,
have a dlsclalmer (see secLlon 4.9.) whlch had Lo be acknowledged before enLerlng Lhe slLe.
1hese slLes were lncluded ln Lhe sample as nelLher reglsLraLlon nor a password was requlred.


16 lbld
17 lbld
18 See 8ose,C. (2012) vlsool metboJoloqles London: Sage
19 lnk, S. (2007) uoloq vlsool tbooqtopby London: Sage
20 8ose op.clL. (1-2)
16

Samp|e of on||ne spaces cons|dered after |nc|us|on and exc|us|on cr|ter|a
app||ed:

lound on search for
pro-anorexia and
vlewed
ro-ana conLenL 8ecenLly updaLed assword
proLecLed
lncluded ln
analysls
MulLl-page
complex
webslLe (CWS)
98 36 30 12 18
lndlvldual
lmage based
slLe (llS)
129 97 43 9 36
lndlvldual blog
(l8)
143 130 76 29 47
MulLl-page
baslc webslLe
(8WS)
72 66 32 7 23
1oLal: 444 349 183 37 126


|e chart to |||ustrate the proport|on of on||ne spaces ana|ysed |n the study:



2.3.3. 1he onllne sample was saved and sysLemaLlcally caLegorlsed uslng an onllne bookmarklng
Lool LhaL saved Lhe speclflc u8Ls of each webslLe or 8log vlslLed. As Lhese slLes can be
unrellable, uslng Lhls resource enabled qulck ldenLlflcaLlon of any slLe LhaL had been recenLly
closed down. AnoLher advanLage of Lhe sLorlng u8Ls, whlch remalned perslsLenL when Lhe
slLe was reLurned Lo, allowed aspecLs of Lhe LexL Lo be hlghllghLed and noLes Lo be aLLached
Lo Lhe webpage LhroughouL Lhe analysls.
21
1he addlLlon of research-generaLed keyword Lags,
Lhe uploadlng of lmages and Lhe faclllLy Lo caLegorlse daLa made Lhls an ldeal Lool Lo collecL,
analyse and sLore Lhe onllne daLa.

21

See hLLp://www.dllgo.com/
17


2.3.4. Cn a more reflexlve noLe lL was lnLeresLlng LhaL Lhrough Lhe daLa collecLlon process Lhe
bookmarklng slLe belng used had clearly Lhe proflled Lhe conLenL of Lhe slLes saved durlng
Lhe research process for LargeLed adverLlslng as Lhe followlng llnk appeared aL Lhe Lop of Lhe
collecLlon:
When cllcked Lhe adverLlsemenL lead sLralghL Lo recovery help, advlce and a LreaLmenL cllnlc.
The advertisements of the researchers personal Facebook profile also changed to offer
dleLs, sllmmlng pllls and oLher welghL loss soluLlons and Lhls was a noLeworLhy developmenL
ln Lhe research process. 1he book-marked collecLlon was ldenLlfled as seeklng lnformaLlon
on anorexla, especlally pro-anorexla and poslLlvely LargeLed wlLh recovery adverLlsemenLs
and llnks for pro-recovery supporL. Powever, lronlcally Lhe amblgulLy assoclaLed wlLh Lhls
Loplc
22
ls also reflecLed ln Lhe adverLlsemenL whlch appeared aL base Lhe bookmarklng page
- one for dleL and welghL loss:


2.3.3. Cnce selecLed Lhe slLes were carefully analysed and wlLh conslderaLlon glven Lo key
concepLs ldenLlfled ln Lhe llLeraLure revlew a codlng frame was developed. An lnlLlal sample
was analysed ln relaLlon Lo Lhe codlng frame, exlsLlng Lheorles and llLeraLure ln order Lo
ascerLaln vlablllLy. 8oLh conLexLual and concepLual codes were used. ConLexLual codes
provlded background lnformaLlon, for example, Lhe Lype of webslLe, when lL was lasL
updaLed, how many pages lL had and whaL funcLlons lL offered (chaL, lmages, LexL, dleLary
lnformaLlon, creeds eLc.) and concepLual codes provlded lnformaLlon abouL Lhe naLure and
caLegorles of conLenL. 1hls process was repeaLed wlLh all Lhe webslLes selecLed unLll no new
relevanL concepLs emerged and LheoreLlcal saLuraLlon was reached.
23



22

See secLlon 3.4.1.
23 See SLrauss, A. and Corbln, !. (1998) 8oslcs of Ooolltotlve keseotcb. CtoooJeJ 1beoty ltoceJotes ooJ 1ecbolpoe (2oJ Jo.) London: Sage.


18

2.6. Acronyms used |n the report

Lu LaLlng dlsorder
An Anorexla nervosa
Ana Anorexla
Mla 8ullmla
ro-ana ro-anorexla
ro-mla ro-8ullmla
8Lu 8lnge LaLlng ulsorder
LunCS LaLlng dlsorder noL oLherwlse speclfled
uCC user CeneraLed ConLenL
LM LxplanaLory model

19


3. Understand|ng LD and pro-LD
3.1. 1hls revlew ls noL lnLended Lo be a medlcal accounL of Lhe dlsease, buL ln order Lo
undersLand Lhe pro-ana, pro-mla and pro-Lu communlLles under dlscusslon lL ls lmporLanL
Lo clarlfy Lhe use of Lermlnology ln order Lo undersLand conLemporary concerns ln relaLlon
Lo Lhese onllne envlronmenLs and Lhe aLLracLlveness Lo Lhose LhaL use Lhem.

3.2. Anorexla nervosa (AN) is associated with long-Lerm physlcal and psychologlcal dlsablllLy
due to its chronic course and acute medical complications
24
and dlsplays llLLle dlfference ln
males and females alLhough male onseL Lends Lo be laLer.
23


3.3. Anorexla ls a dlsorder (or lllness) whlch sLems from low self-esLeem and an lnablllLy Lo cope
safely wlLh worrles and problems and lnvolves lowerlng food lnLake by sklpplng meals and
cuLLlng down Lhe Lypes and amounLs of food eaLen, some people over-exerclse as well.
26


3.4. 8ullmla ls also a dlsorder llnked wlLh self-esLeem, emoLlonal problems and sLress. eople
may consLanLly Lhlnk abouL calorles, dleLlng and ways of geLLlng rld of Lhe food Lhey have
eaLen. 8ullmla ls more common Lhan anorexla, buL ls more of a hldden lllness, because
people wlLh bullmla usually remaln an average or [usL over average body welghL. eople
wlLh bullmla may become lnvolved ln a cycle of eaLlng a very large amounL of food, maklng
Lhemselves slck, cuLLlng down or sLarvlng for a few days or Lrylng Lo flnd oLher ways Lo make
up for Lhe food Lhey have eaLen. Some people wlll noL vomlL buL wlll Lake laxaLlves: boLh
behaviours may be described as purging by medical professionals but taking laxatives is
parLlcularly dangerous physlcally.
27


3.3. 8lnge LaLlng ulsorder (8Lu) and Compulslve CvereaLlng lnvolve eaLlng large amounLs of
food ln a shorL perlod of Llme (perhaps noL aL a normal mealLlme) and feellng a lack of
conLrol durlng Lhese blnges, buL unllke someone wlLh bullmla nervosa, people do noL Lry Lo
expel Lhe food.
28


3.6. LaLlng dlsorders labelled noL oLherwlse speclfled (LunCS) are very complex whlch means
LhaL Lhere can be varlaLlons ln Lhe Lyplcal slgns and sympLoms and LhaL noL all of Lhe slgns
and sympLoms wlll apply Lo all people. 1here are many people LhaL are dlagnosed wlLh
LunCS. 1hese are dlsorders where people have some buL noL all of Lhe dlagnosLlc slgns for
anorexia or bulimia; they may also be diagnosed with a partial syndrome eating disorder.
29


3.7. eople wlLh an eaLlng dlsorder are also llke Lo suffer from oLher menLal healLh lssues and
frequenLly also suffer from depresslon or soclal anxleLy.
30
1hls ls slgnlflcanL Lo Lhls sLudy of
onllne envlronmenLs as research has found poslLlve relaLlonshlps beLween depresslve mood
and rlsk behavlours and LhaL Lhose found Lo be hlgh ln depresslve mood were more llkely Lo
go onllne Lo communlcaLe.
31



24 ulmlLropoulos, C., klopfer, k., Lazar, L. and SchacLer, 8. (2009: 330) Carlng for a Slbllng wlLh Anorexla nervosa: A CuallLaLlve SLudy. ln otopeoo otloq ulsotJets kevlew 17 pp. 250-J65.
23 Crlsp, A. (2006) Anorexla nervosa ln Males: SlmllarlLles and ulfference Lo Anorexla nervosa. ln lemales
.
lo otopeoo otloq ulsotJets kevlew 14 pp 16J-167.
26 8eaL 1ypes of eotloq JlsotJets [onllne] avallable from hLLp://www.b-eaL.co.uk/geL-help/abouL-eaLlng-dlsorders/Lypes-of-eaLlng-dlsorder1/
27 lbld.
28 lbld.
29 lbld.
30 !uarasclo, A. S., Shaolb, A. and 1lmko, C. A. (2010) ro-LaLlng ulsorder CommunlLles on Soclal neLworklng SlLes: A ConLenL Analysls. lo otloq ulsotJets vol. 18 pp. J9J-407.

31 Pwang, !. M., Cheong, . P. and lreely, 1.P. 8elng young and feellng blue ln 1alwan: examlnlng adolescenL depresslve mood and onllne and offllne acLlvlLles. lo New MeJlo ooJ 5oclety vol. 11 (7) pp. 1101-1121.
20

3.8. ln a sLudy of 130 respondenLs
32
who had vlslLed a pro-ana slLe 84 had an eaLlng dlsorder,
46 also experlenced problems wlLh self-harm, 37 anxleLy and panlc aLLacks, 24
depresslon and 24 anoLher Lype of soclal dlfflculLy. 1hus Lhere are many negaLlve effecLs
on physlcal healLh, psychologlcal well-belng and soclal lnLeracLlon of Lhe lndlvldual and on
oLhers around Lhem and people ofLen feel mlsundersLood and lsolaLed.
33


3.9. ConfllcL wlLhln famllles abouL how besL Lo supporL a famlly member wlLh an Lu ls common
and these disagreements can limit the familys ability overall to help.
34
eople wlLh eaLlng
dlsorders ofLen lack soclal supporL
33
and

Lhls need for soclal supporL, comblned wlLh
Lechnologlcal developmenLs whlch allow new onllne communlLles Lo develop qulckly wlLh
llLLle flnanclal cosL, has led Lo Lhe pleLhora of pro-Lu webslLes, onllne forums and
communlLles now onllne.

3.10. A pro-eaLlng dlsorder ls a willingness to accept thaL an lndlvldual has an eaLlng dlsorder
wlLhouL seeklng Lo encourage LhaL lndlvldual Lo flnd LreaLmenL, and may lmply an alm Lo
moLlvaLe or enable conLlnuaLlon of dlsordered eaLlng behavlour.
36
Pro-ana relaLes Lo
lndlvlduals who adopL an anLl-recovery approach ln regard Lo eaLlng dlsorders.
37


3.11. lrom a grounded Lheory analysls of vlrLual eLhnographlc research ln pro-anorexla chaL
rooms and forums, Lhe pro-anorexla model (below) lllusLraLes how people who use pro-
anorexia websites actually want their anorexla because of Lhe poslLlve percepLlon LhaL
Lhey have Lowards lL.
38

1he pro-anorex|a mode| deve|oped by W||||ams and ke|d (2007):


3.12. A pro-eaLlng dlsorder WebslLe ls a collecLlon of lnLerneL pages, all assessed Lhrough a
domaln name or l address, LhaL dellver conLenL abouL eaLlng dlsorder such as anorexla and

32 Cslpke, L. and Porne, C. (2007) pro-LaLlng ulsorder Websites: Users Opinions. lo otopeoo otloq ulsotJets kevlew 15 pp 196-206.

33 Williams, S. and Reid, M. (2010: 552) Understanding the experience of ambivalence in anorexia nervosa: the maintainers perspecLlve. lo lsycboloqy ooJ neoltb vol. 25. No. 5 pp. 551-567.


34 ulmlLropoulos eL al., op. clL.
33 1lller, !.M., Sloane, C., SchmldL, u. and 1roop, n. (1997) Soclal SupporL ln paLlenLs wlLh anorexla nervosa and bullmla nervosa. lo lotetootloool Iootool of eotloq ulsotJets vol. 21 J1-J8.

36 Cslpke and Porne (2007: 197) op. clL.
37 1lerney, S. (2006) 1he uangers and uraw of Cnllne CommunlcaLlon: ro-Anorexla WebslLes and Lhelr lmpllcaLlons for users, racLlLloners, and 8esearchers. ln otloq ulsotJets 14. 181-190.

38 Wllllams and 8eld (2010: 333)

op.clL.

Anorexla can be
consldered a
problem
21

bullmla. 1hls conLenL can be conveyed Lhrough LexL, lmages, or audlo, and lL encourages
knowledge, aLLlLudes, and behavlours Lo achleve Lerrlbly low body welghLs.
39


3.13. 1he lnLerneL has provlded a space for marglnallsed and sLlgmaLlsed groups Lo meeL, share
and exchange lnformaLlon and lL ls Lhrough boLh medlcallzaLlon and sLlgmaLlzaLlon LhaL
parLlclpanLs of Lhe pro-ana movemenL become marglnallzed and seek oLhers who share
Lhelr bellefs Lo flnd effecLlve supporL and acLlvely vlslL and malnLaln pro-ana webslLes,
weblogs and personal pages.
40


3.14. There are a number of factors that might explain why extreme communities form on the
lnLerneL. 1he ma[orlLy communlcaLe Lhrough LexL-based medlums, such as emall llsLs,
newsgroups or web-based bulletin boards that provide users with visual anonymity
41
.
Cnllne anonymous envlronmenLs, Lherefore, allow people Lo express vlews abouL Lhelr
disorder that would be judged negatively in other surroundings. ro-sites for those with
poslLlve bellefs abouL a sLlgmaLlsed behavlour exlsL for oLher behavlours also such as drug
use, self-harm and sulclde.
42
Thus cyberspace has emerged as a crlLlcal conLexL for Lhe
consLrucLlon of alLernaLlve ldenLlLles and narraLlves relaLlng Lo eaLlng dlsorders. ln recenL
years, an array of anorexlc narraLlves has been publlshed on Lhe lnLerneL presenLlng Lhe
lnLlmaLe everyday experlences and nuances of llvlng wlLh an eaLlng dlsorder.
43

4. kesearch I|nd|ngs

4.1. ro-ana webslLes are hypermedla envlronmenLs Lhey are a dlverse and ofLen eclecLlc mlx
of LexL, webllnks, fllm and lmage some of whlch are user generaLed and oLhers are Laken
from oLher medla and embedded ln Lhe webslLe or 8log. 1he term convergence describes
Lhe spread of conLemporary vlsual culLure, Lhe mulLlple ways medla conLenL ls accessed and
Lhe merge beLween more corporaLe medla and ever lncreaslng parLlclpaLory culLure.
44
1he
pro-ana/Lu phenomena onllne reflecLs Lhls paradlgm shlfL.

4.2. 1o conslder rlsk ln Lerms of a passlve audlence vlewlng harmful conLenL would be a Loo
slmpllsLlc analysls of Lhe complexlLy LhaL ls boLh performed and experlenced ln Lhese dlverse
onllne envlronmenLs. 1hus rlsk ls noL from Lhe Lechnology buL from a complex lnLerplay
beLween people wlLh an eaLlng dlsorders, dlglLal convergence and lncreaslng hypermedla
envlronmenLs faclllLaLed Lhrough unmedlaLed vlrLual spaces.

4.3. 1he Lype of vlrLual envlronmenL wlLhln whlch Lhe slLes are hosLed ls also lmporLanL Lo
undersLandlng Lhe conLenL and naLure of use of varlous onllne spaces. noL all pro-Lu
webslLes are Lhe same, an asserLlon LhaL ls borne ouL by Lhe dlfferenL Lypes of webslLes and
onllne communlLles LhaL were observed and recorded. Some webslLes are mulLl-paged,
hlghly sophlsLlcaLed wlLh a complex array of conLenL and mulLlple affordances
43
complex
mulLl-page weblLes (CWS). CLher webslLes, alLhough comprlslng of several pages were far
more baslc by deslgn and ln Lerms of conLenL (8WS), hundreds of soclal neLworklng slLes and

39 8orzekowskl, u. L. C., Schenk, S., Wllson, !. L. and eebles, 8. (2010: 1326) e-Ana and e-Mla: A ConLenL Analysls of ro-eaLlng dlsorder WebslLes. lo Ametlcoo Iootool of lobllc neoltb 100 8 pp. 1526-15J4.


40 Paas, S. M., lrr, M. L., !ennlngs, n. A. and Wagner, L. M. (2011) Communicating Thin: A grounded model of online negative support groups in the pro-anorexia movement. In New MeJlo ooJ 5oclety vol. 1J oo 1 pp 40-
37.
41 8ell, v. (2007: 431) Cnllne lnformaLlon, exLreme communlLles and lnLerneL Lherapy: ls Lhe lnLerneL good for our menLal healLh? ln Iootool of Meotol neoltb vol. 16 oo 4 pp 445-457.
42 Wllllams and 8eld op. clL.
43 8lch, L. (2006: 293) anorexlc dls(connecLlon): managlng anorexla as an lllness and an ldenLlLy. lo 5ocloloqy of neoltb ooJ llloess vol. 28. No. J pp 2J4-J05.
44 !enklns, P. (2008) coovetqeoce coltote. wbete OlJ ooJ New MeJlo colllJe new ?ork: new ?ork unlverslLy press.
43 See PuLchby, l. (2001). 1echnologles, 1exLs and Affordances. ln 5ocloloqy, J5(2), 441-456
22

lndlvlduallsed weblogs (l8) and more lmage based slLes hosLed, for example, on ?ou1ube or
1umblr.

4.4. 1he popularlLy of soclal neLworklng slLes whlch have capLured common communlcaLlon and
selfldenLlLy dlscourse ls reflecLed ln Lhe number of pro-ana groups on soclal neLworklng
slLes and Lhese slLes are more focused on soclal aspecLs llke lnLeracLlon and soclal supporL
raLher Lhan on speclflc conLenL relaLlng Lo an eaLlng dlsorder whlch ls more common on
lnLerneL based webslLes.
46


4.3 1he lnlLlal search for Lhls sLudy found LhaL many webslLes, alLhough sLlll ln exlsLence, had
noL been updaLed for a few years, nearly 40 had noL been updaLed for a few monLhs buL
oLhers were hlghly acLlve and updaLed regularly someLlmes several Llmes per day. 1hus
Lhere ls a dlverslLy ln Lhe currency of Lhe pro-Lu webslLes buL Lhere was clear evldence of
webslLes shuLLlng down, or belng shuL down buL lSs, and Lhen seLLlng up elsewhere under
a dlfferenL name buL wlLh slmllar, someLlmes ldenLlcal conLenL.

4.6 1he pro-ana community is substantial
47
and Lhe rlse of Lhe popularlLy of Lhe lnLerneL and
new medla has played a slgnlflcanL parL ln provldlng easler access Lo lnformaLlon on how Lo
dleL, sLay Lhln and malnLaln an eaLlng dlsorder. 1he pro-Lu communlLy ls Lhus descrlbed as a
phenomenon that has constructed itself by gradually increasing numbers of websites and
their members into a community of practice and Lhere are esLlmaLed Lo be beLween 400-
300 pro-Lu webslLes avallable onllne.
48


4.7 1hese flgures are, however, unrellable as Lhe slLes are LranslenL and nomadlc by naLure as
Lhey ofLen geL shuL down elLher by lSs or by Lhe creaLors Lhemselves buL Lhen emerge
elsewhere under dlfferenL name. As a resulL researchlng Lhls rapldly changlng Lechnologlcal
envlronmenL ls challenglng. Many u8Ls ouLllned ln prevlous sLudles had dlsappeared when
Lhe fleld-work for Lhls sLudy Look place.

4.8 As dlscussed above (4.3.3) some slLes were very complex, had hundreds of users and
dlfferenL pages for dlfferenL funcLlons and Loplcs. 1he more complex mulLl-pages slLes were
well ordered, very well organlzed and up-Lo-daLe clalmlng someLlmes over 2,600 members
aL Lhe Llme of Lhe research fleldwork. Accordlng Lo webslLe sLaLlsLlcs Lhere had been 1,380
Loplcs under dlscusslon on some slLes ln dlfferenL chaLrooms across nearly 13,000 posLs. ln
LoLal many webslLes had over 23 dlfferenL onllne areas Lo explore and each had several
webpages and addlLlonal chaL faclllLles and forums. 1hese complex slLes have an
lnLernaLlonal followlng and are acLlve for 24 hours a day due Lhelr global appeal. 1hey offer
a new members forum, a forum Lo Lalk abouL dlfferenL Lypes of eaLlng dlsorders, a chaL
room for members who were pro-recovery (whlch lncluded clear LexL based lnsLrucLlons
requesLlng users dld noL posL anyLhlng LhaL could be consldered Lrlggerlng) and forums for
dlscusslons abouL famlly lssues. 1here were oLhers for dlscusslons and advlce on Lraumas,
for example, relaLlng Lo abuse. 1he opporLunlLy Lo find an anabuddy - an onllne frlend, for
supporL and advlce was provlded by oLher chaL rooms where users could exchange emall or
conLacL deLalls Lo communlcaLe wlLh each oLher away from Lhe more publlc forum
envlronmenLs. A large proporLlon of Lhe slLes ls dedlcaLed Lo Lhlnspo (see perfecLlon ln
secLlon 3.1), phoLographs and aspecLs speclflcally Lo compeLlLlons and dleLlng challenges.
Many webslLes also had forums for dlscusslng lssues relaLed Lo self-harm (Lhls was usually

46 !uarasclo eL al. op. clL.

47 Parshbarger, !. L., Ahlers-SchmldL, C. 8., Mayans, L., Mayans, u. And Pawklns, !. P. (2009: 369) pro-Anorexla WebslLes: WhaL a Cllnlclan Should know. ln lotetootloool Iootool otloq ulsotJets vol. 42 pp. J67-J70.
48 Clles, u. (2006: 464) ConsLrucLlng ldenLlLles ln cyberspace: 1he case of eaLlng dlsorders. ln 8tltlsb Iootool of 5oclol lsycboloqy vol. 45 pp. 46J-477
"

23

clearly lndlcaLed) and also pages dedlcaLed Lo fashlon, medla, muslc and llLeraLure as well as
arL, poems, healLh and beauLy and llnks Lo oLher pro-Lu webslLes. 1he seemlngly speclflc
pro-Lu focus of Lhe slLes was slLLlng ln amongsL more mundane and seemlngly everyday
dlscusslons Lo be found on many oLher webslLes and chaL forums. lL ls lmporLanL Lo
conLexLuallse Lhese slLes and Lhelr use ln Lhe undersLandlng of users everyday llves.

4.9. 1he slLes varled ln Lhelr Lone and conLenL ln relaLlon Lo be pro-Lu. 1he sample lncluded
more moderaLe pro-Lu slLes, very openly ro slLes and some uncompromlslng pro-Lu slLes
(whlch all Lend Lo be run by Lhose wlLh eaLlng dlsorders Lhemselves). 32 of Lhe 126 slLes
sampled lncluded a warnlng/dlsclalmer on Lhe fronL page:









4.10. 1he lnLerneL has provlded a space for marglnallsed and sLlgmaLlsed groups Lo meeL, share
and exchange lnformaLlon. lL ls Lhrough boLh medlcallzaLlon and sLlgmaLlzaLlon LhaL
parLlclpanLs of Lhe pro-ana movemenL become marglnallzed and seek oLhers who share
Lhelr bellefs Lo flnd effecLlve supporL and Lhrough acLlvely vlslLlng and malnLalnlng pro-ana
webslLes, weblogs and personal pages.
49
1he prevalence of flrsL Llme use ls also of concern.

4.11. PlghllghLed by a sLudy ln Lhe neLherlands (wlLh Lhe cooperaLlon of one of Lhe largesL weblog
provlders), Lhe lncldence of flrsL Llme vlslLs (as denoLed by Lhe absence of cookles) Lo pro-
ana slLes ln one year (1sL CcLober 2006- 30Lh SepLember 2007) was 337,964.
30


4.12. Cnllne anonymous envlronmenLs allow people Lo express vlews abouL Lhelr dlsorder LhaL
mlghL be [udged negaLlvely ln oLher surroundlngs and many dlfferenL Pro-sites for those
wlLh poslLlve bellefs abouL a sLlgmaLlsed behavlour exlsL for oLher behavlours such as drug
use, self-harm and sulclde.
31
1he 2011 Lu klds onllne reporL hlghllghLed LhaL 21 11-16 year
olds ln Lhelr research had been exposed Lo one or more Lypes of poLenLlally harmful user
generaLed conLenL: haLe (12), pro-anorexla (10), self-harm (7), drug-Laklng (7) and/or
sulclde (3).
32


4.13. 1he age aL whlch people vlslL pro-Lu slLes ls, Lherefore, an lncreaslng concern. As menLloned
10 of 9-16 year olds ln Lhe Lu klds onllne sLudy had vlslLed a pro-anorexla webslLe,
33
Lhe
ma[orlLy of users of pro-ana slLes are young and female buL Lhey are also used by boys and
young men.
34
Cne 8elglan sLudy of 711 secondary school chlldren found LhaL 12.6 of glrls
and 3.9 of boys had vlslLed pro-ana webslLes.
33



49 Paas eL al. op.clL.
30 Martijn, C.; Smeets, E.; jansen, A.; Hoemans, N.; Schoemaker, C.; (2009) Dont Get the message: The Effect of a warnlng 1exL before vlslLlng a roanorexla WebslLe. ln lotetootloool Iootool otloq ulsotJets vol 42. pp
1J9-145.
31 Wllllams and 8eld op. clL.
32 LlvlngsLone, S., Paddon, L., Crzlg, A. and Clafsson, k. (2011) u klJs oolloe llool tepott avallable onllne from www.eukldsonllne.neL
33 lbld.
34 Cslpke and Porne op. clL.
33 CusLers, k. and van den 8ulck, !. (2009) vlewershlp of ro-Anorexla WebslLs ln SeenLh, nlnLh and LlevenLh Craders. ln otopeoo otloq ulsotJets kevlew vol. 17 pp. 214-219.

welcome to joome of slte]
1bls ls o pto ooo webslte. lt ls oot ootl tecovety bot lf yoo ote tecovetloq ftom oo
eotloq JlsotJet tbeo yoo sboolJ leove oow. 1bls webslte bos cooteot wblcb moybe
ttlqqetloq. lf yoo Jo oot bove oo eotloq JlsotJet pleose leove oow. lf yoo Jo oot
oqtee wltb pto ooo tbeo pleose leove oow.
1bls webslte ockoowleJqes tbot tbete ote Jlffeteot vlews oo pto ooo bot tbls
webslte belleves pto ooo ls fot tbe soppott of people wbo bove eotloq JlsotJets
bot ote oot yet teoJy to tecovet. 1bot ls wbot tbls webslte ls fot.

24

4.14. A slgnlflcanL number of slLes are acLually creaLed by glrls under 18 years old.
36
Powever, lL
should be noLed LhaL in media use research it is not uncommon to find rapid changes ln
behavlour beLween generaLlons. ?ounger cohorLs are llkely Lo embrace new Lechnologles aL
a hlgher level Lhan Lhose who wenL before Lhem.
37
SeLLlng up and malnLalnlng a webslLe or
8log requlres a baslc level of dlglLal skllls and many chlldren ln prlmary schools are able Lo
masLer web deslgn and managemenL.

4.13. users of pro-ana webslLes score hlgher on a deslre for Lhlnness, perfecLlonlsm and 8ody
Mass lndex (8Ml) and ln poslLlve aLLlLudes Lowards pro-ana webslLes.
38
Lus are ofLen
acLually seen as poslLlve by Lhose who have Lhem
39
and lL ls ofLen suggesLed LhaL pro-ana or
pro-Lu webslLes clalm LhaL An ls noL a dlsease buL a cholce of llfesLyle.

4.16. 1he relaLlonshlp beLween an eaLlng dlsorder and llfesLyle cholce ls explored ln much of Lhe
publlshed llLeraLure on Lhe sub[ecL and it is perhaps helpful to consider that lifestyle does
noL necessarlly lmply a noLlon of cholce, rather, it is a lifestyle in the sense of a way of life
that pervades every aspect of the persons LhoughL, percepLlon and acLlon.
60


4.17. 1he conLenL on Lhe slLes consldered ln Lhls sLudy varled enormously and conslsLed of LexL
and lmage based conLenL, user generaLed conLenL and conLenL Laken from oLher sources.
1he Lype and formaL of Lhe onllne space (l.e. WebslLe, 8log, soclal neLwork) clearly
lnfluenced Lhe naLure and formaL of Lhe conLenL of Lhe slLes. lL ls perhaps also worLh noLlng
LhaL lL ls Lhe avallablllLy and accesslblllLy of some of Lhe more harmful conLenL, ln Lerms of
boLh LexL and lmage LhaL are of currenL concern, and Lhe focus of conLemporary academlc
debaLe.

4.18. 1he rlsk ln relaLlon Lo Lhese onllne spaces ls undersLood, Lherefore, as a relaLlonshlp
beLween Lhe accesslblllLy and avallablllLy of Lhese slLes, Lhe frequency of Lhe vlslLs, Lhe
naLure and conLenL and of Lhe slLe and vulnerablllLy and/or Lhe reslllence of Lhe user.


36 norrls, M. L., 8oydell, k. M., lnhas, L. and kaLzman, u.k. (2006) Ana and Lhe lnLerneL: A revlew of ro-Anorexla WebslLes. ln lotetootloool Iootool of otloq ulsotJets vol. J9. 6 pp 44J-447.
37 CusLers and van den 8ulck op.clL.
38 lbld

39 (Wllllams and 8eld op. clL.
60 Cslpke and Porne op.clL.

k|sks |dent|f|ed |n re|at|on to pro-LD webs|tes:
lncreaslng accesslblllLy and avallablllLy of pro-Lu webslLes,
onllne forums and blogs,
Lhe naLure and conLenL of slLes varles accordlng Lo Lype of
onllne space,
rlsk varles accordlng Lype of conLenL and frequency of vlslLs,
rlsk varles accordlng Lo vulnerablllLy of user.
23


1he r|sk re|at|onsh|p:


S. key themes

lour maln Lhemes emerged from Lhe analysls of Lhe onllne daLa drawn from 126 pro-Lu
webslLes and onllne spaces. All Lhe webslLes lncluded ln Lhe sLudy were carefully
documenLed, analysed and coded. 1he lnlLlal codlng was Lhen grouped furLher and
relaLlonshlps beLween Lhe caLegorles analysed and commenLed on. Cverall Lhe daLa falls
lnLo four key Lhemes.








S.1. erfect|on

3.1.1. erfecLlon appears here as a caLegory of rlsk. 1he phrase sLarvlng for perfecLlon ls a
popular Lag llne on pro-Lu webslLes and lL ls ln Lhe pursulL of perfecLlon LhaL Lhe rlsk acLually
lles. 1he perfecL body ls a soclal and a culLural consLrucLlon and Lhe concepL of perfecLlon
was Lhe mosL domlnanL Lheme Lo emerge from Lhe daLa analysls of Lhe pro-Lu onllne
envlronmenLs. Images of perfect bodies especlally celebrlLy bodles almed aL lnsplrlng
welghL loss appeared alongslde dlscusslons and advlce on how Lo achleve a perfecL body
domlnaLed Lhe slLes consldered.

26

3.1.2. lL ls noL LhaL Lhe slLes clalm LhaL anorexla or bullmla are glamorous and deslrable llfesLyle
cholces, buL Lhe prevalllng mood of these sites seems to be yes Lhese are dlseases whlch
are dangerous Lo your physlcal and menLal healLh, buL bearlng LhaL ln mlnd here ls Lhe
lnsplraLlon Lo carry on lf you wanL Lo, or feel you have Lo.
61
1hls lnsplraLlon, seen ln Lhe
form of lmages and known as thinspiration, are lmages of ofLen beauLlful, ofLen falry-llke,
very Lhln bodles, buL also reverse-thinspiration with plcLures of people wlLh obeslLy.

3.1.3. ln Lhe pro-Lu communlLy perfecLlon ls Lhlnness. 1he vlewlng of and sLrlvlng for Lhlnness
underplns Lhe pro-Lu culLure. 1he LhlnsplraLlon conLenL of Lhese slLes ls well documenLed
elsewhere
62
and owlng Lo careful conslderaLlon of Lhe reporLlng guldellnes ouLllned by 8eaL
acLual lmages from Lhe webslLes whlch could be consldered Lrlggerlng are noL lncluded for
lllusLraLlon ln Lhls reporL.

3.1.4. 1hlnsplraLlon lmages of celebrlLles are orlglnally publlshed onllne elsewhere, of course, and
had been copled from oLher medla sources. 1here ls a conslderable dlscourse of concern ln
relaLlon Lo Lhe medla consLrucLlon of Lhlnness ln general as exempllfled by recenL
governmenL and pollcy lnlLlaLlves. Powever, in a medla saLuraLed culLure, Lhe argumenL
LhaL long Lerm exposure can help shape Lhe world vlews of parLlcular secLlons of Lhe
audlence ls one LhaL merlLs conslderaLlon, however, Lhe Lx1Ln1 Lo whlch Lhe medla
conLrlbuLe Lo Lhe personal ldenLlLy remalns unclear and ls sub[ecL Lo conLlnulng academlc
debate.the media do not, by their very definition, provide pure experience of the world
buL channel our experlence of lL ln parLlcular ways.
63


3.1.3. 1he pro-ana webslLes conLalned page upon page of LhlnsplraLlon feaLurlng celebrlLles, for
example, kelra knlghLley, vlcLorla 8eckham, Cerl Palllwell, Mary-kaLe and Ashley Clsen (Lo
name buL a few) looklng very glamorous, sllm, wlLh bones clearly deflned ln Lhe lmage. 1he
ma[orlLy were noL dlsslmllar Lo Lhe glossy fashlon magazlnes avallable ln Lhe hlgh sLreeL. A
sklm Lhrough vogue, 1aLler, Parpers or CosmopollLan ln a local newsagenL would generaLe a
slmllar range of lmages ln relaLlon Lo Lhe feaLured celebrlLles and fashlon models.

3.1.6. Naturalistic and experimental research repeaLedly flnds LhaL Lhe medla, ln Lhe form of
magazlnes, Lelevlslon and fllm, play a slgnlflcanL role ln negaLlvely lnfluenclng body lmage
and eaLlng for many lndlvlduals.
64
WhaL ls more slgnlflcanL here ls Lhe parLlcular audlence
vlewlng Lhe lmages ln Lhls pro-ana envlronmenL.

3.1.7. 1he soclal ls Lhus perhaps Lhe mosL lmporLanL modallLy for undersLandlng Lhe audlenclng
of lmages. ln parL Lhls ls a quesLlon of Lhe dlfferenL soclal pracLlces LhaL sLrucLure Lhe
vlewlng of parLlcular lmages ln parLlcular places. vlsual lmages are always pracLlced ln
parLlcular ways, and dlfferenL pracLlces are ofLen assoclaLed wlLh dlfferenL klnds of lmages
ln dlfferenL klnds of spaces.
63



61 Llpczynska, S. (2007: 346) ulscoverlng Lhe CulL of Ana and Mla: A revlew of pro-anorexla webslLes. ln Iootool of Metol neoltb vol 16 No. 4 pp 545-548.
62 8orzekowskl eL al. op clL.
63 !ade, u. (2009) 1he Medla and eaLlng dlsorders naLlonal CenLre lor LaLlng ulsorders [onllne] avallable from hLLp://www.eaLlng-dlsorders.org.uk/medla-and-eaLlng-dlsorders.hLml
64 8ardone-Cone, A. M. and Cass, k, M. (2006: 236) lnvesLlgaLlng Lhe lmpacL of ro-Anorexla WebslLes: A lloL SLudy. ln otopeoo otloq ulsotJets kevlew 14 pp 256-262.
63 8ose op.clL. (31)

27


3.1.8. lL ls Lhus Lhe vulnerablllLy of Lhls speclflc audlence LhaL ls slgnlflcanL raLher Lhan Lhe lmages
of Lhemselves. CfLen accompanled by LexL enLrles elLher from Lhe slLe auLhor/edlLor or from
a vlewer, lmages would aLLracL commenLs, for example, under a phoLographlc lmage of
kelra knlghLly was wrlLLen:






3.1.9. 1he LhlnsplraLlon secLlon of webslLes and enLrles on lndlvldual 8log and soclal neLwork slLes,
Lhough, were noL always celebrlLy model based. Many lmages were user CeneraLed ConLenL
(uCC) lmages of communlLy members Lhemselves, whlch were ofLen copled across many
dlfferenL forums, slLes and onllne spaces. Slmllar or even Lhe same lmages were copled
across from one slLe Lo anoLher and ofLen appeared many Llmes. WhllsL speclflc lmages are
noL lncluded ln Lhls reporL for eLhlcal reasons and Lhe reporLlng guldellnes ouLllned by 8eaL,
Lhe Coogle screen shoL below lllusLraLes Lhe Lype and varleLy of Lhlnspo avallable [usL
Lhrough Coogle lmages:



























3.1.10. 1he range of lmages deplcLed above ls lllusLraLlve of Lhe dlverslLy of lmages found on pro-
ana slLes. Some deplcL emaclaLed, almosL skeleLal bodles, some are hlghly sexuallsed (as
lllusLraLed by arrows) some are of celebrlLles or fashlon models and oLhers are uCC from
pro-ana forums. CfLen only cerLaln body parLs are shown ln Lhe lmage Lhe ldea of
perfecLlon assoclaLed wlLh havlng a gap aL Lhe Lop of Lhlghs or ln Lhe dlsplay of bony parLs of
She is so beautiful and she is so thin. I want to look just like her.....

28

Lhe body. WhllsL very few celebrlLy phoLographs were of Lhe celebrlLy looklng unkempL,
dlshevelled or emaclaLed Lo Lhe polnL of skeleLal, some of Lhe uCC lmages, were of
exLremely Lhln, emaclaLed and skeleLal bodles, frequenLly ln a sLaLe of undress showlng
collar bones, hlp bones, Lops of LlghLs and knees as well as elbows, backbones and rlbs.

3.1.11. lrequenLly Lhe lmages also had commenLs from Lhe slLe auLhor referrlng Lo 8Ml or a cerLaln
weight. One image tagged emaciated was accompanied by text claiming that Lhe sub[ecL
lnLended Lo lose anoLher 13 lbs. 8esearch suggesLs LhaL Lhe vlewlng of Lhese lmages has a
negaLlve lmpacL on mood and self-esLeem and parLlclpanLs reporLed feellng low when Lhey
vlslLed slLes and felL worse abouL Lhelr body lmage as a resulL whlch overall dlscouraged
Lhem from seeklng recovery.
66


3.1.12. 1hese LhlnsplraLlon lmages were also a promlnenL feaLure of Lhe more llnear 8log and lmage
sharlng slLes such as 1umblr and ?ouLube where Lhey had been cllpped LogeLher Lo form a
movlng monLage of Lhlnness. 1he lmages on personal blogs and less complex spaces ofLen
aLLracLed commenLs boLh poslLlve and negaLlve from oLher users of Lhe slLes. lL ls Lhls
lnLeracLlve conLacL and conducL LhaL also forms Lhe basls of Lhe rlsk analysls ln relaLlon Lo
Lhese slLes buL for dlfferenL reasons.

3.1.13. lL ls Lhe normallslng Lendencles of exLreme behavlours ln onllne envlronmenLs LhaL
compounds Lhe rlsk of vlewlng Lhe lmages and sLrlvlng Lo be underwelghL ls deemed noL
only as normaLlve buL as a slgnal as success.
67
CompeLlLlon Lo become a beLLer anorexlc ls
prevalenL on Lhese slLes.
68
NoL only ls anorexla vlewed as a llfesLyle cholce, buL Lhose who
embrace lL are pralsed for Lhe deslrable quallLies involved in being a successful anorexic:
conLrol over oneself, self-dlsclpllne and Lhe denlal of pleasure and nourlshmenL.
69


3.1.14. CurrenL concerns ln relaLlon Lo vlewlng Lhese lmages are, Lherefore, noL [usL ln relaLlon Lo
Lhose wlLh an Lu as Lhere ls sLrong evldence LhaL exposure Lo pro-anorexla webslLes has
lmmedlaLe and negaLlve effecLs on young women: regarding behavioural expectations, pro-
anorexla webslLe vlewers [women wlLhouL a hlsLory of an Lu] reporLed LhaL vlewlng Lhe
webslLe made Lhem more llkely Lo exerclse and Lhlnk abouL Lhelr welghL ln Lhe near fuLure
(Loday or Lomorrow) Lhan lf Lhey had noL seen Lhe webslLe.
70
Lven modesL exposure Lo pro-
Lu webslLes can encourage slgnlflcanL changes ln calorle consumpLlon and lncreased
dlsordered eaLlng behavlours
71
. CauLlon, however, needs Lo be exerclsed ln LhaL Lhe pro-ana
community should not be viewed as a universally coherent standpoint.
72


3.1.13. lL ls also Lhe sexuallsed naLure of many of Lhe lmages has caused concern. ?oung women
have reporLed belng Largeted for Skinny porn. According to reports porn agencles'
webslLes slgn up new cllenLs and adverLlse lmages, fllms and escorL-Lype servlces, such as
body worshlpplng, fanLasy role play and prlvaLe phoLography sesslons, for Lhose "hooked on
sklnnles". Some of Lhls porn ls free Lo access whlle oLher "professlonal" agencles charge a
monLhly membershlp fee for regularly updaLed sexually expllclL lmages and vldeos of
emaclaLed women. Agencles also hosL anorexla porn on ?ou1ube and adverLlse on anorexla
pornography forums .
73



66 Plgbed, L. and lox, !. 8. L. (2010) lllness percepLlons ln anorexla nervosa: A quallLaLlve lnvesLlgaLlon. ln 8tltlsb Iootool of cllolcol lsycboloqy vol. 49. pp J07-J25.
67 8orzekowskl eL al. op.clL. (1332)
68 see also 8lch op.clL.
69 Cslpke and Porne op.clL. (197)
70 8ardone-Cone and Cass op.clL. (344)
71 !eLL, S., LaorLe, u. !. and Wanchlsn, !. (2010) lmpacL of Lxposure Lo ro-LaLlng ulsorder WebslLes on LaLlng behavlour ln College Women. ln otopeoo otloq ulsotJets kevlew vol. 18 pp. 410-416.
72 Clles op.clL. (464).
73 Hobbs, N. (2011) Anorexic women targeted by 'super-skinny' porn websites in 1be CootJloo, weJoesJoy 6 Aptll 2011
29

3.1.16. ln order Lo achleve perfecLlon, slLes offer advlce on how Lo lose welghL and furLher welghL
loss. 1he ma[orlLy of Lhese Llps and Lrlcks dlscuss welghL conLrol, calorle conLenL of food and
how Lo calculaLe a 8Ml. Much of Lhls conLenL ls avallable elsewhere on malnsLream welghL
loss/dleL webslLes, magazlnes and healLh/exerclse medla. Powever, lL ls clear from Lhe
research Lo daLe LhaL Lhe use of unregulaLed lnformaLlon could lead Lo serlous
consequences for lndlvlduals wlLh an Lu.
74
ln pursulL of perfecLlon many anorexlcs are
prepared Lo sLarve Lhemselves ln order Lo carry on loslng welghL. 1he harsh reglmes whlch
lnclude advlce on purglng, Laklng dleL pllls and laxaLlves and dleLs recommendlng mlnlmal
calorle consumpLlon LogeLher wlLh harsh exerclse reglmes ouLllned on some slLes would be
consldered exLreme Lo say Lhe leasL.

3.1.17. The idea of disordered perfection appears very popular and agaln ls a common phrase on
Lhe slLes. 1here ls evldence Lo suggesL LhaL Lhere ls recognlLlon LhaL Lhe ldeal or ldea of
perfection when living with an eating disorder is disordered. In striving to achieve
perfecLlon Lhe users of Lhe slLes perform Lhelr achlevemenLs Lhrough onllne documenLaLlon
of lmages and LexL. One blog described it as warped perception LhaL even when Lhey
had losL welghL when Lhey looked ln Lhe mlrror Lhey dld noL see perfecLlon and LhaL Lhey
sLlll felL faL even Lhough Lhey reached Lhelr goal welghL. ln pursulL of perfecLlon Lhey Lhen
furLher reduced Lhelr goal welghL Lo an even lower LargeL:






3.1.18. 1he advlce on how Lo conLrol welghL and conLlnue welghL loss ls glven Lhrough promoLlng
cerLaln behavlours from exerclse, resLrlcLlng dleL and purglng. 1hls quoLe from a webslLe has
been puL Lhrough Wordle (an online tool for generating word clouds from text). 1he
clouds glve greaLer promlnence Lo words LhaL appear more frequenLly and Lhe ldenLlLy of
Lhe source ls proLecLed ln Lhe presenLaLlon of Lhe reporL:




74 see for example Parshbarger, !. L., Ahlers-SchmldL, C. 8., Mayans, L., Mayans, u. And Pawklns, !. P. (2009) pro-Anorexla WebslLes: WhaL a Cllnlclan Should know. ln lotetootloool Iootool otloq ulsotJets vol. 42 pp. J67-
370.

I've now reached uoJet my qool welqbt!!!! .) lppee!!!! Now fot o oew lowet
goal weight!

30

3.1.19. Much of Lhe advlce abouL dleLs lncludes mosL malnsLream popular dleLs such as
welghLwaLchers, ALklns, Cabbage soup and l plan dleLs, for example, wlLh Lhe sLrengLhs and
llmlLaLlons for each deLalled. CLher dleLs are more severe lncludlng Lhe Ana 8ooL camp or
A8C dleL whlch:








3.1.20. 1he calorle consumpLlon recommended per day varles buL Lends noL Lo exceed 400-300
calorles per day and ofLen Lhe recommended lnLake ls less. Accordlng Lo Lhe nPS (onllne) an
average man needs around 2,300 calorles a day Lo sLay healLhy and for an average woman,
LhaL flgure ls around 2,000 calorles a day.
73
1he healLh rlsks of followlng Lhese dleLs ln Lhe
long Lerm are well documenLed.

3.1.21. Cne webslLe auLhor advocaLes Lhelr own dleL whlch advlses mlnlmal lnLake of food, loLs of
waLer and dleL soda, plenLy of clgareLLes, coffee and dleL pllls. 1hus concerns based on Lhe
ideas around disordered perfection consider the viewing of perfection as not a
normal/average weight body but a thin body still striving to lose more weight. The thin
body becomes normallsed ln Lhese envlronmenLs and perfecLlon becomes an ever shlfLlng
goal.

3.1.22. nearly 90 of Lhe slLes analysed conLalned LhlnsplraLlon maLerlal and over 80 conLalned
overL lnformaLlon on personally engaglng ln pro-eaLlng dlsordered behavlour (nb Lhe slLes
were lncluded ln Lhe research sample on Lhls basls). 8esearch suggesLs LhaL the content
feaLured on Lhese slLes could lead Lo lmmedlaLe and llfe-LhreaLenlng problems.
76
SLrlvlng Lo
be Lhln ls of paramounL lmporLance ln users llves, recordlng deLalls of varlous aLLempLs
underLaken ln order Lo reach a deslred welghL goal buL, whllsL users appear Lo undersLand
Lhe damaglng naLure of cerLaln acLlvlLles, Lhls does noL resLrlcL Lhelr efforLs or even
dangerous behavlours Lo lose welghL.
77








73 nPS Anorexla nervosa [onllne] avallable from hLLp://www.nhs.uk/CondlLlons/Anorexla-nervosa/ages/lnLroducLlon.aspx
76 8orzekowskl eL al. op.clL. (1331)
77 1lerney op.clL.
8lsks ldenLlfled:
Seeklng a dlsordered vlew of perfecLlon
normallslng of ulLra Lhln body lmage
Lxposure Lo exLreme or dangerous dleLlng advlce or behavlours
Low self-esLeem and lacklng ln self-confldence
lasts for 50 days. It has a different amount of calories allocated for each day and the
Jlet olso locloJes fosts oo some Joys. lt ls boseJ oo tbe lJeo tbot by cbooqloq tbe colotle
consumption eat day you keep your metabolism guessing so that it doesnt slow down.
jsome wotJs sobstltoteJ].

31


S.2. erform|ng

3.2.1. 1he concepL of performlng lllusLraLes how users of pro-Lu slLes perform Lhelr self-ldenLlLy
and lndeed Lhelr Lu or ana ldenLlLy ln onllne envlronmenLs. erformance refers Lo acLlvlLles
of an lndlvldual before a seL of observers and suggesLs LhaL everyone ls playlng a role.
78
1he
lnLerneL, as a Lechnology offers dlfferenL affordances
79
and Lhls secLlon examlnes Lhe
lnLeracLlons beLween Lhe users and Lhe dlfferenL onllne spaces ln Lhe pro-Lu communlLles.
lnLeracLlon ls deflned as the reciprocal influence of individuals upon one anothers actions
ln performance, and may be deflned as all Lhe acLlvlLy of a glven parLlclpanL on a glven
occaslon whlch serves Lo lnfluence ln any way any of Lhe oLher parLlclpanLs.
80
lL ls Lhese
lnLeracLlons wheLher beLween Lhe lndlvldual and web space conLenL or beLween Lhe
lndlvlduals and oLhers, whlch are dlscussed here, and consldered ln relaLlon Lo rlsk and pro-
Lu web spaces.

3.2.2. Cne of Lhe needs Lo Lhe Lhln sLems from havlng a low self-esLeem
81
and Lhese slLes allow
sLlgmaLlsed or soclally lsolaLed lndlvlduals Lo share experlences anonymously in a rich
LapesLry of ldenLlLy work.
82
1here are a pleLhora of asynchronous blogs and onllne dalrles
LhaL clalm Lo be pro-ana. Some are more LexL based ln a dlary formaL held on popular 8log
slLes and oLhers are more lmage based wlLh sLlll lmages LhaL are popular on phoLo sharlng
webslLes and movlng/fllm lmage on slLes such as ?ouLube.

3.2.3. 1hese more personal, lndlvlduallsed spaces reflecL how cyberspace has emerged as a
crlLlcal conLexL for Lhe consLrucLlon of alLernaLlve ldenLlLles and narraLlves relaLlng Lo eaLlng
dlsorders. ln recenL years, an array of anorexlc narraLlves has been publlshed on Lhe
lnLerneL presenLlng Lhe lnLlmaLe everyday experlences and nuances of llvlng wlLh an eaLlng
dlsorder.
83


3.2.4. 1he personallsed narraLlves performed ln vlrLual envlronmenLs are ofLen hyperllnked Lo
each other in a recommended or I am following list and frequently have images and quoLes
from LexL repllcaLed and re-blogged from each others slLes. 1he pro-Lu communlLy onllne ls,
Lherefore, undersLood as a phenomenon that has constructed itself by gradually increasing
numbers of webslLes and Lhelr members lnLo a communlLy of pracLlce.
84


3.2.3. 1he lmporLance of undersLandlng Lhe role of Lhe lmage as a dlglLal arLefacL underplns Lhe
analysls presenLed here. 1he role of slgn vehlcles and arLefacLs ln presenLlng Lhe lmage of
self and wanLlng Lo porLray cerLaln deslred characLerlsLlcs ls hlghly slgnlflcanL ln Lhese
envlronmenLs and Lhe sharlng of conLenL ls llnked Lo self-ldenLlLy and Lo belonglng Lo a
culLural, soclal or gendered group.
83


3.2.6. Cne lndlvldual lmage-based blog lncorporaLed over 360 separaLe lmages, all black and whlLe,
some were cllps from fllms, some sLlll lmages of celebrlLles, oLhers were drawlngs, doodles,
lmages of Lhe owner buL Lhe overall slLe was carefully and meLlculously consLrucLed an

78 urawn from Coffman, L. (1939) 1be lteseototloo of 5elf lo vetyJoy llfe uoubleday: Carden ClLy, new ?ork.
79 Hutchby, I. (2001) Technologies, Texts and Affordances. In 5ocloloqy vol. J5 No. 2 pp. 441-456.
80 Coffman op. clL. (26)
81 karpowlcz, L., SkarsaLer, l. and nevonen, L. (2009) Self-esLeem ln paLlenLs LreaLed for anorexla nervosa. ln lotetootloool Iootool of Meotol neoltb Notsloq vol. 18. lp. J18-J25.
82 Clles op.clL.
83 8lch op.clL.
84 Clles op.clL. (464)

83 Coffman op.clL.
32

arLwork ln lLself. 1hls slLe, LogeLher wlLh 27 of Lhe overall sample slmllarly presenLed, also
conLalned lmages of self-harm, and lmages llnked Lo depresslon and sulclde.
3.2.1. ln addlLlon Lo uslng lmages nearly all of Lhe more 8log based slLes had deLalled calorle
consumpLlon lnformaLlon ofLen on a day-Lo-day basls. LxacLly whaL an lndlvldual had
consumed and how many calorles each lLem consumed conLalned ls posLed ln meLlculous
deLall LogeLher wlLh reflecLlons of Lhe bloggers consumpLlon hablLs. WhllsL everyday llfe ls
Laken up Lrylng Lo avold food mosL 8logs reflecL a preoccupaLlon wlLh food ln LhaL Lhe
bloggers Lhlnk abouL food consLanLly and obsesslvely. leellngs of success and achlevemenL
assoclaLed wlLh excesslvely low calories intakes or on completing a day or twos fasting
compeLe wlLh harsh, self-punlshlng reacLlons Lo eaLlng more Lhan ln Lhe prevlously declded
upon dleL. 1hese negaLlve, punlLlve feellngs were frequenLly assoclaLed wlLh oLher
reflecLlons relaLed Lo self-harm and self-loaLhlng.

3.2.2. Thus the users of the sites obtain and maintain an identity of a successful ana or a failing
ana in detailing their diet activities which are used as identity markers or cues onllne
proving that they are a worthy ana.

3.2.3. 1he blogs, chaL rooms and onllne forums all deLall everyday human experlences and
responses Lo llfe evenLs noL [usL ln relaLlon Lo anorexla buL also famlly or frlends,
relaLlonshlps or work/school experlences. ueallng wlLh docLors and Lhe medlcal professlonal
appear frequenLly here LogeLher wlLh dlscusslons of feellngs of low self-worLh/self-esLeem
or feellng good because welghL loss has been achleved.

3.2.4. Alongslde Lhe lmages and dleL based Lalk many blogs are hlghly self-analyLlcal and assume
quasl-rellglous connoLaLlons of Lhe confesslonal whlch are also reflecLed ln Lhe conLenL and
posLlngs of a large number of webslLes. 1he slLes frequenLly conLalned leLLers Lo ana, ana
creeds and poems reflecLlng of Lhe LhoughLs and vlews of Lhe auLhors. uue Lo malnLalnlng
Lhe anonymlLy of Lhe auLhor Lhe poem deplcLed below has been pasLed lnLo Wordle.





















3.2.3. 1he leLLers and creeds Lo ana have a rellglous llke quallLy Lo Lhem and many are beauLlfully
lllusLraLed wlLh drawlngs and oLher arL work. 1he use of Lhese rellglous meLaphors and Lhe
33

rellglous or splrlLual naLure of Lhe slLes abound wlLh creeds or leLLers Lo ana and also
goddess llke analogles ln relaLlon Lo ana or Lo Lhe creaLor of Lhe slLe.
86





















3.2.6. EaLlng dlsorders revolve around privacy and secrets
87
and the efforts of stigmatized
persons not only normify their own conduct but also encourage others to embody the
sLlgmaLlsed behavlour.
88
Cne dlary based 8log descrlbed welghL galn followlng some weeks
at home over the ChrlsLmas perlod. Cn reLurnlng Lo college Lhe 8logger wroLe LhaL she was
golng Lo underLake a Lhree day fasL Lo gain control again. Within two hours of the posting
Lhe 8logger had 36 followers also declarlng LhaL Lhey would also fasL for Lhree days ln
supporL. Sharlng ls lmporLanL Lo relaLlonshlps and ls based on LrusL and lnLlmacy and
undersLandlng Lhe reclprocal dependence and famlllarlLy
89
ln Lhe pro-ana communlLy ls
essenLlal.

3.2.7. lL ls boLh Lhe secreLlve naLure of Lhe pro-anorexla movemenL and Lhe lnLlmacy LhaL
parLlclpanLs feel Lowards Lhe dlsease lLself and one anoLher and LhaL make onllne
envlronmenLs rlpe for self-dlsclosure.
90
Thus concealing anorexic practice is then a symbolic
slLe as Lhese young women sLruggle noL only Lo reasserL Lhelr self-deLermlnaLlon buL also Lo
aLLempL Lo regaln an ldenLlLy, albelL an anorexlc ldenLlLy.
91
1hrough Lhe esLabllshmenL of
an audlence for ana, pro-ana bloggers engage ln co-consLrucLlng personal ldenLlLles LhaL
are ln keeplng wlLh Lhe group ana membershlp Lo flL ln wlLh Lhe expecLaLlons of a percelved
audlence.
92


3.2.8. 1herefore, whllsL Lhese slLes and forums have plcLures of users Lhemselves uploaded for
oLher people Lo commenL on and Lhus offer encouragemenL for welghL loss, Lhese acLlvlLles
acLually nurLure each others harmful behavlour
93
whlch leads Lo an alLernaLlve Lype of

86 norrls eL al.op. clL.
87 klrkwood, 8. (2003: 119). SupporL Cholce, SupporL eople: An ArgumenL for Lhe SLudy of roAnorexla WebslLes. ln Ateoeo. o bllloqool jootool of tbe bomooltles ooJ soclol scleoces, 25(1), 117-129.
88 Coffman op. clL.
89 lbld.
90 Paas eL al. op.clL.
91 8lch op.clL. (298)
92 Paas op.clL. (48).
93 Colllns, ! M. (2004) nurLurlng uesLrucLlon: LaLlng ulsorders Cnllne. ln Off Oot 8ocks Novembet-uecembet pp. 20-22.
34

supporL group - an Cnllne negaLlve Lnabllng SupporL Croup (CnLSC) as Lhey furLher
encourage and supporL negaLlve and ofLen harmful behavlours.
94


3.2.9. Synchronous chaL rooms are dlfferenL ln naLure Lo an asynchronous 8log envlronmenL ln
LhaL Lhey are noL lmage buL LexL domlnaLed. 1he synchronous chaL rooms dlsplay a hlgh
volume of lnLeracLlon and are a popular form of communlcaLlon. urawlng on a symbollc
lnLeracLlonlsL perspecLlve, Lhe loss of self felL by many people wlLh chronlc lllness suggesLs
LhaL lndlvlduals commonly noL only lose self-esLeem, buL even self-ldenLlLy.
93
1hrough Lhe
sharlng palnful experlences and dlscloslng lnLlmaLe feellngs, a pro-ana ldenLlLy ls
sLrengLhened, and Lhe supporL group galns momenLum Lhrough message exchange wlLh an
anonymous audlence. Powever, whilst feeling supported, individuals visiting pro-anorexla
webslLes are llkely become furLher enLrenched ln Lhelr dlsordered eaLlng behavlours and
LhoughLs.
96


3.2.10. 1he chaL rooms vlslLed ln Lhe sLudy dlsplayed a wlde range of Loplcs under dlscusslon
predomlnanLly focused on Lus, and on dlsordered eaLlng. 1he parLlclpanLs ln Lhe chaL rooms
shared lnLlmaLe deLalls abouL Lhelr feellngs and Lhelr fallures and Lhe responses from oLher
members of Lhe groups observed ln Lhe sLudy were malnly supporLlve and poslLlve. 1here
was much dlscusslon ln relaLlon Lo Lhelr relaLlonshlps wlLh oLhers famlly, frlends and
romanLlc parLners ofLen deLalllng Lhe lsolaLlon Lhey felL and Lhe lack of undersLandlng
dlsplayed by non-anas. Talk of visits to docLors or psychologlsLs were frequenL and
dlscusslons abouL doses and prescrlbed medlcaLlon for Lhe LreaLmenL of Lhe Lu and/or
depresslon were common.

3.2.11. new members were someLlmes LreaLed wlLh susplclon lnlLlally. AlLhough lL varles accordlng
Lo Lhe slLe, sub-group and Lhe naLure of Lhe lndlvlduals ln correspondence, supporL ls a key
characLerlsLlc of Lhe chaL rooms, posslbly as a resulL as recelvlng llLLle offllne supporL.
97


3.2.12. 1he pro-ana communlLy places emphasls on medlcal dlagnosls and Lhe Lype of Lu users are
experlenclng. 1here can ofLen be confllcL beLween dlfferenL groups of users as well as
beLween Lhe communlLy and ouLslders as members noL only consLrucL Lhelr self-ldenLlLles as
members of a culLural group buL also as a member of sub-groups (pro-ana, pro-mla or
LunCS) and that of others as normals; wannabes or haters who are the outsiders
98
.
1hus Lhe selecLlve passlng on of pracLlces or Lechnlques of anorexla ls a way of reafflrmlng
noL ldenLlLy, but also ensuring that it is the right and accepted identity.

94 Paas op.clL.
93 Charmaz, k. (1983) Loss of self: a fundamenLal form of sufferlng ln Lhe chronlcally lll. ln 5ocloloqy of neoltb ooJ llloess vol. 5 No. 2 pp. 168- 195.
96 (8ardone-Cone and Cass op.clL. (237).
97 8oLsky and Clles op. clL.
98 Clles op. clL.
33



3.2.13. 1hls label or self-ldenLlLy ls ofLen dlsplayed Lhrough Lhe wearlng a red braceleL and many
onllne many slLes advocaLe Lhe wearlng of a red beaded braceleL as lllusLraLed below:




















3.2.14. 1he research conflrms LhaL LrusL, moblllsed by muLual shared dlsclosure, ls one of Lhe key
susLalnlng dynamlcs of a relaLlonshlp.
99
Powever, Lhe idealized perceptions of others based
on reduced cues, opLlmal self-presenLaLlon and lnformaLlon managemenL Lhrough mlndful
message construction in asynchronous exchanges and the potential for an intensification
loop where extreme views are validated and escalated among members of an a online
group.
100


3.2.13. 1herefore, engaglng wlLh pro-anorexla slLes, relnforces an existing eating disordered
identity and visiting such resources could cement the positive association individuals derlve
from the label anorexic.
101


3.2.16. WhaL ls also characLerlsLlc of Lhese envlronmenLs ls Lhe compeLlLlve naLure of Lhe Lalk
beLween Lhe parLlclpanLs. ?oung women wlLh anorexla seek sancLuary and supporL from
oLher sufferers buL Lhe paradoxlcal naLure of Lhe relaLlonshlp becomes a source of comforL
and compeLlLlon slmulLaneously.
102






99 see Clddens, A. (1991) MoJetolty ooJ 5elf-lJeotlty 5elf ooJ 5oclety lo tbe lote MoJeto Aqe Cambrldge: ollLy ress.
100 Paas eL al. op. clL. (46-47)
101 (1lerney op. clL. (183).
102 8lch op. clL.


8lsks ldenLlfled:
CompeLlLlve naLure of slLes
8elonglng Lo and relnforcemenL of an ouL group
LaLlng dlsordered self-ldenLlLy
LncouragemenL of harmful behavlours
36

S.3. rotect|on

3.3.1. CfLen mlsrepresenLed ln Lhe medla and mlsundersLood by famlly, frlends and even Lhe
medlcal professlon, ls Lhe noLlon LhaL anorexia is not a fad for these girls. It is part of who
Lhey are.
103
1he soclal ldenLlLy of someone wlLh an eaLlng dlsorder ls compllcaLed.
Anorexla funcLlons as a site in which subjectivity is constantly negotiated.
104
1hrough Lhe
performance of perfecLlon (as dlscussed above 3.1 and 3.2) Lhe users of Lhe pro-Lu slLes
achleve self-ldenLlLy as an eaLlng dlsordered person and group ldenLlLy as belonglng Lo Lhe
onllne culLural group. 1he proLecLlon of boLh self-ldenLlLy and Lhe group ldenLlLy and,
lndeed, Lhe eaLlng dlsorder lLself becomes of paramounL conslderaLlon as Lhey sLrlve Lo
proLecL Lhemselves, Lhelr group and Lhelr onllne envlronmenLs from ouLslders and from
belng closed down.

3.3.2. 1he users of Lhe slLes wenL Lo conslderable lengLhs Lo proLecL Lhemselves and Lhelr Lu. 1hey
exchanged deLalled lnformaLlon abouL how Lo hlde Lhe condlLlon form oLhers famlly,
frlends and Lhe medlcal professlon. This is perhaps also suggesLlve of Lhe ways ln whlch
those people with anorexia may come to resist the pathologising stereotypes that often
ensue from Lhelr lnLeracLlons wlLh oLhers.
103


3.3.3. The tips and tricks sections of the sites offered advice on hiding the symptoms of welghL
loss or how Lo prevenL people from noLlclng LhaL a person was noL eaLlng. 1he lndlvldual
8logs also deLalled how dlfflculL lL was Lo hlde Lhe condlLlon:





103 klrkwood op. clL. (117)
104 Clles op. clL. (474)
103 8lch op.clL. (283)

I'm stressing about how om l qoloq to blJe oot eotloq lo ftoot of my fomlly ot bow om l
qoloq to wotk oot tbtee times today.
37


3.3.4. lL was clear from Lhe daLa LhaL Lhe users of Lhe slLes felL lsolaLed and LhaL oLher people
(Lhose wlLhouL an Lu) dld noL undersLand Lhem. 1hey [usLlfled Lhelr behavlours ln order Lo
boLh proLecL Lhemselves buL also proLecL Lhelr Lu. lrequenLly Lhls need for proLecLlon was
lnLenslfled ln Lhe onllne envlronmenLs because of cyberbullylng. ln boLh chaL rooms and on
asynchronous 8logs people commenLed on posLs and on Lhe lmages uploaded. MosLly Lhe
commenLs were encouraglng and supporLlve of welghL loss and Lowards Lhe pro-ana
ldenLlLy buL someLlmes Lhe commenLs were bullylng and aggresslve. 1he followlng example
illustrates [Wordled to protect the identity of the source] the tone and language used in a
bullylng commenL ln response Lo a posL on Lhe blog:


















3.3.3. users also had Lo proLecL Lhemselves from belng LargeLed from people lnLerested in skinny
pornography, sometimes pornography agencies or other types of grooming. Bearing in
mlnd LhaL Lhls ls a vulnerable group ofLen lacklng ln self-esLeem Lhls poses a clear rlsk for
Lhe members of Lhe pro-Lu communlLy. 1he users Lry Lo proLecL Lhemselves and oLhers
from Lhls form of explolLaLlon as Lhe followlng posLs on a 8log lllusLraLes [Wordled to
proLecL Lhe ldenLlLy of Lhe source]:

















38

3.3.6. roLecLlng Lhe group from ouLslders ls an lmporLanL aspecL of Lhe onllne shared spaces. 1he
daLa from Lhe sLudy suggesLs LhaL Lhe pro-Lu communlLles developed a proLecLlve cocoon
of baslc LrusL
106
ln order Lo manage Lhe cllmaLe of rlsk
107
whlch was predomlnanLly posed by
ouLslders. Many webslLes and 8logs were password proLecLed ln order Lo proLecL Lhe
communlLy or lndlvldual from belng reporLed Lo lSs or from belng LargeLed by
unsympaLheLlc ouLslders.

3.3.7. 1hls LhreaL from ouLslders lncluded academlc researchers and one webslLe deLalled Lhe
name, emall address and deparLmenL of a uk unlverslLy researcher who was ldenLlfled for
conLacLlng members of Lhe pro-ana communlLy afLer whlch Lhe slLe was subsequenLly shuL
down.

3.3.8. 8elng password proLecLed or havlng a dlsclalmer are clear examples of conLrol mechanlsms
Lo mlnlmlse Lhe rlsk of belng closed down by lSs. Powever, dlfferenL characLerlsLlcs were
observed ln relaLlon Lo dlfferenL webslLes and communlLles ln LhaL asynchronous dlscusslon
boards and noLlce boards Lend noL Lo be password proLecLed buL LhaL synchronous chaL
rooms and onllne envlronmenLs do Lend Lo be password proLecLed.
108


3.3.9. Many lSs have blocked slLes and oLhers lnslsL LhaL slLes lncorporaLe dlsclalmers and
warnlngs regardlng Lhe mlnlmum age of Lhe user and Lhe facL LhaL some conLenL may be
upseLLlng.
109
lnformaLlon on purglng, for example, ls noL permlLLed.
110
learful of negaLlve
publlclLy and ln response Lo lncreaslng publlc concerns, lSs have ln recenL years, sLarLlng
wlLh ?ahoo, made slgnlflcanL aLLempLs Lo close down pro-ana slLes.
111
ln response pro-Lu
slLes may use elaboraLe (or noL so elaboraLe) dlsclalmers (see 4.3.9) Lo Lry Lo avold belng
shuL down and proLecL Lhe onllne communlLy.

3.3.10. lL ls Lhrough Lhe pro-Lu onllne communlLles LhaL users obLaln a sense of belonglng whlch
relnforces Lhelr ldenLlLy as an anorexlc or as a bullmlc or oLher eaLlng dlsordered person and
whlch can make leavlng Lhe group Lo seek recovery dlfflculL
112
as no longer belng anorexlc
would entail the loss of a particular subject position.
113



106 See Coffman op clL.
107 See 8eck, u. (1992) klsk 5oclety 1owotJs o New MoJetolty London: Sage and Clddens op. clL.
108 8roLsky and Clles op. clL.
109 Clles op. clL.
110 norrls op. clL.
111 Plll , A. (2001) Clrls ln danger as anorexlcs glve welghL-loss Llps on web 1be Obsetvet, 5ooJoy 12 Aoqost 2001
112 Cslpke and Porne op. clL. (203)
113 8lch op. clL. (299)
8lsks ldenLlfled:
8ullylng
lsolaLlon from famlly and frlends offllne
uefendlng behavlours Lo malnLaln dlsorder
roLecLlon self and group ldenLlLy prevenL lndlvlduals from seeklng
recovery
39


S.4. aradoxes

3.4.1. lL ls Lhe paradoxlcal relaLlonshlp beLween pro-Lu and self/group-ldenLlLy LhaL ls
fundamenLal Lo undersLandlng Lhe rlsk ln relaLlon Lo pro-ana communlLles onllne as
anorexlcs/eaLlng dlsordered people experlence amblvalence Lowards Lhelr condlLlon. As
Lhey experlence and have boLh poslLlve and negaLlve feellngs abouL Lhelr Lu,
114
evldence
suggesLs LhaL Lhe users of pro-ana onllne communlLles also vlew anorexla as a serlous
dlsease LhaL requlres LreaLmenL.
113


3.4.2. eople wlLh eaLlng dlsorders ofLen have boLh poslLlve and negaLlve emoLlons abouL boLh
Lhe anorexla lLself and Lhe ldea of recovery. 1he sub[ecLlve percepLlons of Lhe pro-Lu
webslLes users are LhaL whllsL Lhey undersLand Lhem as harmful, (as Lhey encourage
dlsordered eaLlng and compeLlLlon beLween users has a negaLlve lmpacL ln self-esLeem)
Lhey also vlew Lhe slLes as enabllng Lhem Lo recelve supporL Lo malnLaln resLrlcLed eaLlng
and dlsordered eaLlng behavlours and Lo obLaln valuable emoLlonal supporL.
116


3.4.3. lL ls Lhls relaLlonshlp LhaL ls key Lo undersLandlng Lhe amblvalence Lo LreaLmenL and
change.
117
lamllles of Lhe person wlLh an eaLlng dlsorder also flnd lL hard Lo accepL Lhe lack
of lncenLlve and moLlvaLlon Lo recover and Lo change behavlour.
118
users vlslL Lhese slLes Lo
elLher susLaln or lncrease dlsordered eaLlng behavlours, Lhey obLaln food and exerclse
lnformaLlon, for LhlnsplraLlon and tips and tricks. However, users also reported receiving
valued soclal supporL whlch had a poslLlve effecL on menLal healLh and, whllsL passlve
parLlclpaLlon (vlewlng slLes) ls assoclaLed wlLh malnLalnlng an Lu, acLlve parLlclpaLlon
(communlcaLlng ln chaL rooms) ls assoclaLed wlLh emoLlonal supporL.
119


3.4.4. eople wlLh an Lu are ofLen noL well undersLood by Lhelr famllles, frlends or Lhe medlcal
professlon and Lhls moLlvaLes Lhem Lo flnd alLernaLlve conLexLs where Lhey can flnd
sancLuary, supporL and comforL wlLh oLher suffers.
120
1he anonymous naLure of onllne
envlronmenLs may be more comforLable for people who do noL wanL or have access Lo face-
Lo-face supporL.
121
ro-anorexlc slLes are, Lherefore, appeallng, Lhe parLlclpanLs have lssues
ln common and develop poslLlve supporLlve relaLlonshlps wlLh each oLher demonsLraLlng
Lhelr love for each oLher ln Lhe onllne envlronmenLs.
122


3.4.3. 1here are many dlfferenL perspecLlves ln relaLlon Lo Lhe pro-Lu debaLe and ln splLe of Lhe
dlverslLy, lL ls Lhe lncreaslng avallablllLy and popularlLy of pro-Lu slLes LhaL ls concernlng for
healLh professlonals.
123
Anorexla, seen negaLlvely by healLhcare professlonals as a dlsorder
Lo be LreaLed and cured, ls vlewed dlfferenLly by Lhose acLually experlenclng anorexla, who
do noL see lL as problemaLlc.
124




114 see also lreedman, C., Lelchner, ., Manley, 8., Sanduhu, . and Wang, 1. (2006) undersLandlng Anorexla nervosa 1hrough Analysls of 1hemaLlc ConLenL of LeLLers ln an AdolescenL sample. ln otopeoo otloq
ulsotJets kevlew vol 14. lp J01-J07.
113 Wllllams and 8eld op.clL.

116 Cslpke and Porne op. clL.
117 Plgbed and lox op .clL.
118 ulmlLropoulos eL al., op. clL.
119 Cslpke and Porne op. lL.
120 8lch op. clL.
121 1lerney op. clL.
122 Wllllams and 8eld op. clL.
123 CusLers and van den 8ulck op. clL.
124 Wllllams and 8eld op. clL. (332)
40

3.4.6. This narrow medicalized view of suffering, solely defined as physical discomfort ignores or
minimizes the broader significance of the suffering experienced by chronically ill
123
buL
research, drawlng on a femlnlsL, posL-sLrucLural analysls of lnLervlews wlLh young women
wlLh an Lu, hlghllghLs flrsLly how Lhey felL dlsconnecLed from frlends, famlly, Leachers and
health professionals and secondly what she terms the public privileging of the visual
dlmenslons of lllness.
126


3.4.7. ln explalnlng Lhese seemlngly opposlng vlewpolnLs, Lhe pro-ana phenomenon challenges Lhe
medical, social and feminist perspectives that view anorexia as an illness to be cured.
1here are dlfferenL explanaLory models (LM)
127
, of anorexla whlch lllusLraLe how anorexla ls
percelved by healLh professlonals as a hlghly dangerous condlLlon, by soclal sclenLlsLs and
femlnlsLs as a consequence of WesLern culLural preoccupaLlons or Lo paLrlarchy buL by Lhose
wlLh an Lu as a source of securlLy and predlcLablllLy.
128
1hese dlfferlng vlewpolnLs are
fundamenLal Lo undersLandlng Lhe use of pro-ana slLes.
129




6. Understand|ng r|sk Conc|us|ons

6.1. ercepLlons of rlsk connecL lndlvlduals, communlLles and Lhe soclal sLrucLure.
130
1hls reporL
presenLs Lhe flndlngs from a slx monLh onllne sLudy funded by nomlneL LrusL Lo explore Lhe
rlsk ln relaLlon Lo pro-ana and pro-Lus webslLes. ln summary Lhe rlsks reflecL Lhe relaLlonshlp
beLween Lhe lncreaslng accesslbly and avallably of pro-Lu webslLes, onllne forums and 8logs
and Lhe naLure and conLenL of Lhe onllne spaces. 1he rlsk varles accordlng Lo Lhe amounL of
Llme spenL onllne ln Lhe pro-Lu communlLles, Lhe frequency of slLe vlslLs and Lhe lndlvldual
vulnerablllLy of Lhe user.

6.2. ln order Lo undersLand Lhe rlsk, lL ls essenLlal Lo undersLand how people wlLh eaLlng dlsorders
seek and sLrlve for perfecLlon. 1helr ldea of perfecLlon ls based on a deslre for Lhlnness and
Lhls dlsordered vlewpolnL becomes normallsed Lhrough Lhe vlewlng of lmages and engaglng

123 Charmaz op. clL. (168)
126 8lch op. clL.( 290)
127 narraLlve frameworks used by lay and professlonal people
128 Fox, N. ; Ward, K and ORourke (2005) pro-anorexla, welgh-loss drugs and the internet: an anLl-recovery explanatory model of anorexia. In 5ocloloqy of neoltb ooJ llloess Jol. 10.1111/j.1467-9566.2005.00465.x
pp.944-971
129 lbld.

130 Hart, G. (1997) Introduction in Green, J. klsk ooJ Mlsfottooe 1be 5oclol coosttoctloo of AcclJeots London: uCL ress.

8lsks ldenLlfled:
aradoxlcal relaLlonshlp beLween negaLlve aspecLs of onllne
conLenL and poslLlve aspecLs of onllne supporL.
1he paradox of belng lsolaLed and sLlgmaLlsed offllne buL
ldenLlfylng wlLh and feellng belonglng onllne.
The ambiguous nature of users feelings towards the eating
dlsorder prevenLs Lhem from seeklng recovery.
Cpposlng vlewpolnLs of dlfferenL approaches Lo undersLandlng
Lhe pro-anorexla communlLy.
41

wlLh oLher eaLlng dlsordered people ln onllne envlronmenLs. 1hrough Lhe repeaLed and
conLlnued exposure Lo exLreme dleLlng advlce and dlscusslons Lhelr already poor self-esLeem
and self-confldence are lowered furLher. 1he onllne spaces can be compeLlLlve and furLher
encourage harmful behavlours. Cyberbullylng ls frequenL and users are someLlmes LargeLed
for pornography buL lL ls Lhe feellng of belonglng Lo and ldenLlfylng wlLh Lhe group LhaL
relnforces an eaLlng dlsordered self-ldenLlLy especlally as people wlLh an eaLlng dlsorder are
ofLen lsolaLed and sLlgmaLlsed ln Lhe offllne world.

6.3. lL ls Lhe sense of belonglng LhaL can prevenL lndlvlduals from seeklng help Lowards recovery
and Lhey may furLher defend Lhelr behavlours ln order Lo malnLaln Lhelr dlsorder.
lurLhermore, Lhe dlfferenL and someLlmes opposlng vlewpolnLs ln undersLandlng Lhe pro-Lu
communlLy make undersLandlng Lhe rlsk ln relaLlon Lo pro-ana and pro-Lu webslLes even
more complex. lL ls Lhe paradoxlcal relaLlonshlp beLween Lhe negaLlve aspecLs of Lhe onllne
conLenL and Lhe poslLlve aspecLs of onllne supporL comblned wlLh Lhe amblguous naLure of
the individuals feelings towards Lhe dlsease LhaL makes lL so dlfflculL Lo manage Lhe rlsk ln
relaLlon Lo Lhese onllne envlronmenLs. 8lsk refers Lo Lhe probablllLy noL Lhe lnevlLablllLy of
harm
131
and some recommendaLlons are made ln secLlon 7 whlch alm Lo mlnlmlse Lhe
poLenLlal harm posed by pro-ana and pro-Lu webslLes.

6.4. k|sk |n re|at|on to pro-anorex|a webs|tes can be understood as due to the |ncreas|ng
access|b|||ty of pro-LD webs|tes, on||ne forums and b|ogs. 1he nature and content of s|tes
var|es accord|ng to the type of on||ne space. k|sk var|es accord|ng to the type of content and
frequency of v|s|ts and r|sk var|es accord|ng to the vu|nerab|||ty of the user.

6.3. 1he rlsk ls caLegorlsed along four aspecLs:

erfect|on ln seeklng a dlsordered vlew of perfecLlon and Lhe normallslng of an ulLra-Lhln
body lmage, Lhe exposure Lo exLreme of dangerous dleLlng advlce or behavlours and havlng a
low self-esLeem and lacklng ln self-confldence.
erform|ng due Lo Lhe compeLlLlve naLure of Lhe slLes and belonglng Lo and Lhe
relnforcemenL of Lhe ouL group, havlng an eaLlng dlsordered self-ldenLlLy and Lhe
encouragemenL of harmful behavlours.
rotect|on as a resulL of bullylng, Lhe self and group ldenLlLy prevenLlng lndlvlduals from
seeklng recovery, Lhe lsolaLlon from famlly and frlends off llne and defendlng behavlours Lo
malnLaln Lhe dlsorder.
aradoxes derlved from Lhe paradoxlcal relaLlonshlp beLween negaLlve aspecLs of onllne
conLenL and poslLlve aspecLs of onllne supporL, of belng lsolaLed and sLlgmaLlsed offllne buL
identifying with and feeling belonging online. The ambiguous nature of users feelings
Lowards Lhe eaLlng dlsorder prevenLs Lhem from seeklng recovery and Lhe opposlng
vlewpolnLs of dlfferenL approaches Lo undersLandlng Lhe pro-anorexla communlLy.

131 LlvlngsLone eL al. op clL. (30)
42


7. kecommendat|ons
7.1. Lducat|on and awareness ra|s|ng

7.1.1. vlsual lmagery ls never lnnocenL, lL ls always consLrucLed Lhrough varlous pracLlces,
Lechnologles and knowledges. A crlLlcal approach Lo vlsual lmages ls Lherefore needed: one
LhaL Lhlnks abouL Lhe agency of Lhe lmage, conslders Lhe soclal pracLlces and effecLs of lLs
vlewlng, and reflecLs on Lhe speclflclLy of LhaL vlewlng by varlous audlences, lncludlng Lhe
academlc crlLlc.
132


7.1.2. Awareness ralslng ln relaLlon Lo Lhe rlsks from ro-Anorexla slLes ls problemaLlc. PealLh
professlonals, educaLors, parenLs, carers need Lo be aware of ro-Anorexla slLes and Lhe rlsks
Lhey may pose buL lL ls lmporLanL noL Lo unnecessarlly adverLlse Lhelr exlsLence Lo chlldren
and young people. LducaLlonal sLraLegles almed aL chlldren and young people should
emphaslse Lhe lmporLance of crlLlcal Lhlnklng around vlsual lmages ln relaLlon Lo Lhe wlder
conLexL of harmful conLenL onllne.

7.1.3. 1he Lu klds Cnllne (2011) sLudy, Lhe mosL comprehenslve sLudy on rlsks, young people and
Lhe lnLerneL Lo daLe, emphaslses Lhe lmporLance of developlng crlLlcal medla llLeracy and self-
proLecLlve skllls as well as Lhe role of self-regulaLory and/or co-regulaLory managemenL of
onllne envlronmenLs.
133
lL ls essenLlal LhaL educaLlon responses Lo rlsky onllne spaces are
based on developlng crlLlcal medla llLeracy skllls.

7.1.4. A comprehensive approach to improve childrens and young peoples InLerneL safeLy ls
requlred Lhrough Lhe uk Councll for Chlld lnLerneL SafeLy
134
, and lndusLry self-regulaLlon. An
lnLegraLed e-safeLy sLraLegy and a clear acLlon plan ls essenLlal whlch lncludes pro-eaLlng
dlsorder slLes ln Lhelr dlscusslons of harmful web-conLenL.

7.1.3. lurLhermore, Lhe measures proposed ln Lhe 8yron acLlon plan Lo ralse awareness of e-safeLy
amongsL parenLs and Leachers should speclflcally address pro-eaLlng dlsorder slLes and Lhelr
harmful effecLs. Such educaLlonal efforLs need Lo be coordlnaLed wlLh wlder efforLs Lo
educaLe parenLs and Leachers ln Lhe early deLecLlon and managemenL of eaLlng dlsorder
sympLoms.
133


7.1.6. 1o Lhls end carefully deslgned and approprlaLe awareness ralslng resources are requlred.
CrganlzaLlons llke ChlldneL lnLernaLlonal are fundamenLal ln helplng chlldren and young
people Lo use Lhe lnLerneL consLrucLlvely. Childnet Internationals role ls glvlng advlce Lo
chlldren, lndusLry, organlzaLlons, parenLs, Leachers and carers abouL lnLerneL safeLy Lo proLecL
chlldren from belng explolLed ln Lhe onllne envlronmenLs provlded by new Lechnologles as
well as seeklng Lo lnlLlaLe and respond Lo pollcy changes.

132 8ose op clL. (17)
133 LlvlngsLone eL al. op.

clL.
134 See hLLp://www.educaLlon.gov.uk/ukccls
133 8eaL losltloo lopet oo lto-Aootexlo ooJ lto-8ollmlo websltes WrlLLen by Lhe 8oyal College of sychlaLrlsLs ln collaboraLlon wlLh 8eaL. [onllne avallable from hLLp://www.b-eaL.co.uk/abouL-beaL/medla-cenLre/press-
releases/poslLlon-paper-on-pro-anorexla-and-pro-bullmla-webslLes/
43


7.2 Understand|ng r|sk and harm |n re|at|on to young peop|e

7.2.1. 21 of Luropean chlldren have encounLered webslLes conLalnlng poLenLlally harmful user
generaLed conLenL such as slLes conLalnlng haLe messages, pro-anorexlc and pro-bullmlc
slLes, slLes promoLlng self-harm or whlch dlscuss drug Laklng. ApproxlmaLely 10 of chlldren
have experlenced some form of personal daLa mlsuse buL Lo daLe llLLle ls known abouL Lhe
effecLs of such experlences.
136


7.2.2. 1he experlence of menLal healLh pracLlLloners and allled professlonals ln Lhls fleld may be
valuable ln addresslng how such poLenLlally negaLlve feaLures of childrens online experience
should be addressed Lhrough pollcy.
137
MenLal healLh professlonals need Lo be equlpped wlLh
up-Lo-daLe lnformaLlon abouL ro-Anorexla webslLes and harmful conLenL onllne. A slgnlflcanL
number of young people are vlslLlng pro-Lu webslLes and onllne forums and furLher research
lnLo undersLandlng why young people use Lhem and Lhelr vlew and experlences of Lhese slLes
ls desperaLely needed.

7.1. Med|a respons|b|||ty

7.3.1. Accordlng Lo 8eaL
138
Lhe medla coverage of eaLlng dlsorders LhaL elLher glamorlses or else
Lrlvlallses Lhe lllness makes lL harder Lo bulld Lhe klnd of compasslonaLe undersLandlng LhaL ls
so vlLal Lo beaL an eaLlng dlsorder as people wlLh eaLlng dlsorders are mosLly so ashamed and
dlsgusLed wlLh Lhemselves, Lhelr llves are ruled by lnLense fear and dread and Lhelr self-
esLeem ls so low LhaL Lhey ofLen do noL feel Lhey deserve Lo llve, much less geL LreaLmenL Lo
recover.

7.3.2. 8eaL has called upon Lhe medla noL Lo make pro-ana webslLes lnLo headllne news, noL Lo
reporL Lhelr conLenL ln a sensaLlonallsed way and noL Lo reporL how Lo access Lhem, as Lhls
may lead Lo lncreased use of such slLes. Culdance for Lhe medla on reporLlng of pro-ana slLes
should be parL of Lhe developmenL of wlder guldance Lo Lhem on de-sensaLlonallslng
reporLlng on eaLlng dlsorders ln general.

7.3.3. lL ls Lhelr need Lo be undersLood, Laken serlously and noL [udged harshly by oLhers LhaL can
someLlmes drlve people wlLh eaLlng dlsorders Lo seek refuge and supporL ln Lhe desperaLely
dangerous pro-anorexla and pro-bullmla webslLes LhaL prey on Lhelr lnsecurlLles and furLher
Lrap Lhem ln Lhe lllness. Concerns ln relaLlon Lo Lhe pro-eaLlng dlsorder phenomena are
reflecLed ln Lhe currenL medla dlscourses and medla coverage frequenLly hlghllghL Lhe
poLenLlal dangers of Lhese slLes.

7.3.4. Powever, Lhe publlclLy exempllfles Lhe double-edged sword of modernlLy
139
ln LhaL whllsL,
the ever-foollsh medla aLLempLs Lo educaLe young glrls of Lhe danger, Lhey accldenLly
glamorise the disease.
140
8eporLlng eaLlng dlsorders honesLly, LruLhfully and wlLh compasslon
for Lhose affecLed makes a Lremendous dlfference. lL helps overcome Lhe sLlgma and shame
many people feel maklng lL easler for Lhem Lo accepL Lhe LreaLmenL and supporL Lhey need

136 LlvlngsLone eL al. op. clL.
137 lbld.
138 8eaL op. clL.

139 As dlscussed by Clddens, A. (1990) 1be coosepoeoces of MoJetolty Cambrldge: ollLy ress.
140 Colllns op. clL. (20)
44

Lo beaL an eaLlng dlsorder.
141
1he medla, Lherefore, needs Lo Lake a responslble role ln
ldenLlfylng, represenLlng and dlscusslng Lhls Loplc.
142


7.4. Deve|op|ng a cu|ture of respect

7.4.1. LaLlng dlsorders ofLen leave sufferers feellng lsolaLed, ashamed and cuL off from supporL. Cn-
llne supporL ls an easlly accesslble and powerful way of provldlng supporL Lo Lhose people.
?oung people wlLh eaLlng dlsorders and Lhelr famllles need Lo be able Lo access repuLable
sources of lnformaLlon and supporL such as LhaL provlded by 8eaL.

7.4.2. revlously poslLlve aLLlLudes Lo anorexla have been dlsmlssed as an lrraLlonal consequence of
Lhe dlsorder. Powever, lL ls recommended LhaL Lhe pro-anorexla phenomena should be Laken
serlously ln order Lo develop a more sophlsLlcaLed approach Lo LheoreLlcal models LhaL
conslder Lhe poslLlve moLlves Lo malnLalnlng Lhe condlLlon.
143


7.4.3. Arguing the voice for the pro-ana community (whllsL noL advocaLlng Lhe pracLlce of pro-ana),
Kirkwood considers that we are not as troubled by the conditions which help Lo creaLe
anorexla or wlLh anorexla lLself or else we would be worklng as acLlvely Lo prevenL lL as some
do to remove the websites and suggests that the pro-ana communlLy Lo be vlewed Lhrough
Lhe lens of dlsablllLy.
144


7.S. Warn|ngs

7.3.1. ro-eaLlng dlsorder webslLes are llkely Lo be seL up and malnLalned by young people who
Lhemselves have an eaLlng dlsorder. ln vlew of Lhls, maklng Lhem lllegal would lead Lo
crlmlnallslng a vulnerable group of young people. 1he 8yron
145
acLlon plan menLlons 1he '[olnL
worklng beLween lndusLry and Lhe Lhlrd secLor Lo lmprove Lhe supporL offered Lo vulnerable
groups, lncludlng provldlng llnks Lo supporL servlces and lmprovlng moderaLlon pracLlces
where users dlscuss harmful behavlours'. 1hese measures should be exLended Lo expllclLly
lnclude pro-eaLlng dlsorders webslLes.
146


7.3.2. EffecLlve censorshlp on Lhe lnLerneL ls near lmposslble, and LhaL such aLLempLs wlll prevenL
only Lechnlcally naive users from accesslng such conLenL and communlcaLlng wlLh oLhers.
147

ro-Lu webslLes are unllkely Lo dlsappear and research demonsLraLlng Lhe negaLlve
consequences of pro-Lu webslLes argues for acLlons LhaL mlghL mlnlmlse damage.
148


7.3.3. 1he essenLlal role of lndusLry ls conslsLenLly emphaslsed ln Luropean lnLerneL safeLy pollcy
and expressed Lhrough self-regulaLory codes developed Lo promoLe good pracLlce ln safer
lnLerneL safeLy use.
149
Warnlngs on webslLes are such an example of good pracLlce and can be
an effecLlve sLraLegy.


141 8eaL op. clL.
142 klrkwood op. clL. (128)
143 Wllllams and 8eld op. clL.
144 klrkwood op. clL. (123)
143 8yron, 1. (2008) Safer Chlldren ln a ulglLal World: lull 8eporL [onllne] avallable from hLLp://webarchlve.naLlonalarchlves.gov.uk/20100407120701/dcsf.gov.uk/byronrevlew/
146 8eaL op. clL.
147 8ell op. clL. (431)
148 8ardone-Cone and Cass op. clL. (346)
149 LlvlngsLone eL al. op. clL.

43

7.3.4. 8esearch suggesLs LhaL Lhe warnlng webslLe can be effecLlve wlLh abouL one Lhlrd of lnLended
vlslLs noL LranslaLed lnLo an acLual vlslL Lo a pro Lu slLe subsequenL Lo Lhe warnlng provlded
and a warnlng message on Lhe ouLslde of a webslLe may be helpful ln prevenLlng young
vlslLors from enLerlng Lhe webslLe.
130


7.4. Ioster|ng cr|t|ca| debate

7.6.1. 1o daLe crlLlcal dlscourses have noL only shaped publlc awareness buL also have challenged
LradlLlonal blomedlcal Lheorles.
131
lL ls essenLlal LhaL Lhls debaLe does noL end here buL LhaL
we conLlnue Lo galn furLher lnslghL lnLo Lhe way LhaL culLural seLLlngs lnfluence Lhe
perceptions and peoples experience of a stigmatized mental illness including the way people
who suffer from such a dlsease communlcaLe and express Lhemselves onllne and offllne.
132


7.6.2. lurLher research ls requlred as an improved understanding of the function of these sites in
Lhe llves of Lhose who use Lhem would provlde grounds for a well-lnformed, moderaLe debaLe
on Lhe sub[ecL of pro-anorexla/pro-bullmla webslLes.
133





130 MarLl[n eL al. op. clL.
131 ledyszyn, l. L. and Sulllvan, C. S. (2007: 198) LLhlcal re-evaluaLlon of conLemporary LreaLmenLs for anorexla nervosa: ls an asplraLlonal sLance posslble ln pracLlce? ln Aosttollo lsycboloqlst vol. 42 N. J pp 198-211.
132 Pwang eL al. op. clL. (1106).
133 Cslpke and Porne, op. clL. (198).