Psychological Impact of Pro-Anorexia and Pro-Eating Disorder Websites on Adolescent Females: A Systematic Review.

(1) Background: Teenagers (in particular, females) suffering from eating disorders report being not satisfied with their physical aspect and they often perceive their body image in a wrong way; they report an excessive use of websites, defined as PRO-ANA and PRO-MIA, that promote an ideal of thinness, providing advice and suggestions about how to obtain super slim bodies. (2) Aim: The aim of this review is to explore the psychological impact of pro-ana and pro-mia websites on female teenagers. (3) Methods: We have carried out a systematic review of the literature on PubMed. The search terms that have been used are: "Pro" AND "Ana" OR "Blogging" AND "Mia". Initially, 161 publications were identified, but in total, in compliance with inclusion and exclusion criteria, 12 studies have been analyzed. (4) Results: The recent scientific literature has identified a growing number of Pro Ana and Pro Mia blogs which play an important role in the etiology of anorexia and bulimia, above all in female teenagers. The feelings of discomfort and dissatisfaction with their physical aspect, therefore, reduce their self-esteem. (5) Conclusion: These websites encourage anorexic and bulimic behaviors, in particular in female teenagers. Attention to healthy eating guidelines and policies during adolescence, focused on correcting eating behavioral aspects, is very important to prevent severe forms of psychopathology with more vulnerability in the perception of body image, social desirability, and negative emotional feedback.

Cutting Ties With Pro-Ana: A Narrative Inquiry Concerning the Experiences of Pro-Ana Disengagement From Six Former Site Users.

Websites advocating the benefits of eating disorders ("Pro-Ana") tend to reinforce and maintain restrictive eating and purging behaviors. Yet remarkably, no study has explored individual accounts of disengagement from these sites and the associated meanings. Using narrative inquiry, this study sought to address this gap. From the interviews of six women, two overarching storylines emerged. The first closely tied disengagement to recovery with varying positions of personal agency claimed: this ranged from enforced and unwelcomed breaks that ignited change, to a personal choice that became viable through the development of alternative social and personal identities. A strong counternarrative to "disengagement as recovery" also emerged. Here, disengagement from Pro-Ana was storied alongside a need to retain an ED lifestyle. With "recovery" being just one reason for withdrawal from Pro-Ana sites, clinicians must remain curious about the meanings individuals ascribe to this act, without assuming it represents a step toward recovery.

Inducing Behavioral Change in Seekers of Pro-Anorexia Content Using Internet Advertisements: Randomized Controlled Trial.

BACKGROUND: The influence of pro-anorexia (pro-ana) websites is debated, with studies indicating both negative and positive effects, as well as significant variation in the effects of different websites for those suffering from eating disorders (EDs) and the general population. Online advertising, known to induce behavioral change both online and in the physical world, has not been used so far to modify the search behavior of people seeking pro-ana content. OBJECTIVE: The objective of this randomized controlled trial (RCT) was to examine if online advertisements (ads) can change online search behaviors of users who are looking for online pro-ana content. METHODS: Using the Bing Ads system, we conducted an RCT to randomly expose the searchers for pro-ana content to 10 different ads referring people to one of the three websites: the National Eating Disorders Association, the National Institutes of Mental Health, and MyProAna. MyProAna is a pro-ana website that was found in a previous study to be associated with less pathological online behaviors than other pro-ana websites. We followed participants exposed and unexposed to the ads to explore their past and future online searches. The ads were shown 25,554 times and clicked on 217 times. RESULTS: Exposure to the ads was associated with a decrease in searches for pro-ana and self-harm content. Reductions were greatest among those referred to MyProAna (reduction of 34.0% [73/215] and 37.2% [80/215] for pro-ana and self-harm, respectively) compared with users who were referred elsewhere (reduction of 15.47% [410/2650] and 3.21% [85/2650], respectively), and with users who were not shown the ads, who increased their behaviors (increase of 57.12% [6462/11,314] and 4.07% [461/11,314], respectively). In addition, those referred to MyProAna increased their search for treatment, as did control users, who did so to a lesser extent. However, users referred elsewhere decreased their searches for this content. CONCLUSIONS: We found that referring users interested in ED-related content to specific pro-ana communities might lessen their maladaptive online search behavior. This suggests that those who are preoccupied with EDs can be redirected to less pathological online searches through appropriate pathways. TRIAL REGISTRATION: ClinicalTrials.gov NCT03439553; https://clinicaltrials.gov/show/NCT03439553 (Archived by WebCite at http://www.webcitation.org/6xNYnxYlw).

Pro-ana versus Pro-recovery: A Content Analytic Comparison of Social Media Users' Communication about Eating Disorders on Twitter and Tumblr.

Objectives: To compare how people communicate about eating disorders on two popular social media platforms - Twitter and Tumblr. Materials and Methods: Thematic analysis was conducted to characterize the types of communications posted, and a content analysis was undertaken of between-platform differences. Results: Three types of content (pro-ana, anti-ana, and pro-recovery) were posted on each platform. Overall, across both platforms, extreme pro-ana posts were in the minority compared to anti-ana and pro-recovery. Pro-ana posts (including 'thinspiration') were more common on Twitter than Tumblr, whereas anti-ana and pro-recovery posts were more common on Tumblr. Conclusion: The findings have implications for future research and health care relating to the treatment and prevention of eating disorders. Developers of future interventions targeting negative pro-ana content should remain aware of the need to avoid any detrimental impact on positive online support.

Anorexia and bulimia nervosa: virtual diffusion of the disease as a lifestyle / Anorexia y bulimia nerviosas: difusión virtual de la enfermedad como estilo de vida.

Introduction: Adolescence is a vulnerable period for the onset of eating disorders (ED) such as anorexia and bulimia nervosas. Body dissatisfaction, a precipitating factor for ED, leads adolescents to seek information on the Internet about diets. In this context, pro-Ana (proanorexia) and pro-Mia (probulimia) are on-line pages that promulgate highly harmful contents for health related to weight loss and ED. Objectives: The aim of this study was to analyze quantity, quality and social diffusion strategies used by pro-Ana and pro-Mia webpages. Methods: A web search was done in the Google Chrome browser, using the keywords "anorexia", "bulimia", "eating disorders", "Ana and Mia", "pro-Ana and pro-Mia", "anorexic nation", "obesity", "healthy lifestyles" and "healthy nutrition". The top 20 results for each search were selected and analyzed according to positioning rates (PageRank, PR). The quality of these resources was analyzed by a previously published questionnaire. Finally, a study of the diffusion in social networks like Facebook and Twitter was performed for pro-Ana and pro-Mia pages using SharedCount. Results: Searches for pro-Ana and pro-Mia reported more than a million entries. The pages were poorly positioned. Blog contents were the most shared between all the analyzed pages. Conclusions: pro-Ana and pro-Mia are resources with a clear intention to establish a contact with people with an eating disorder or who are at risk for developing one, in order to strengthen the communication through the blogosphere.

Introducción: la adolescencia es un periodo vulnerable para padecer trastornos de la conducta alimentaria (TCA) como la anorexia y la bulimia nerviosas. La insatisfacción corporal, uno de los factores precipitantes de los TCA, conduce a las adolescentes a la búsqueda de información sobre dietas en internet. En este contexto, las páginas pro-Ana (proanorexia) y pro-Mía (probulimia) difunden contenidos altamente perjudiciales para la salud relacionados con la pérdida de peso y los TCA.Objetivos: en el presente trabajo se analizan la cantidad, el posicionamiento, la calidad y la difusión de las páginas pro-Ana y pro-Mía. Métodos: se realizó una búsqueda de páginas web en el navegador Google Chrome con las palabras clave "anorexia", "bulimia", "trastornos de la conducta alimentaria (TCA)", "Ana y Mía", "pro-Ana y pro-Mía", "anorexic nation", "obesidad", "estilos de vida saludables" y "nutrición saludable". Se seleccionaron los 20 primeros resultados de cada búsqueda según los índices de posicionamiento de PageRank y se analizó la calidad de dichos recursos mediante un cuestionario. Para el estudio de la difusión de páginas pro-Ana y pro-Mía en redes sociales como Facebook y Twitter se utilizó el programa SharedCount. Resultados: pro-Ana y pro-Mía dieron más de un millón de entradas, siendo páginas mal posicionadas, de tipo blog en su mayoría, con mayor difusión en Facebook y Twitter comparadas con otras de mejor calidad. Conclusiones: pro-Ana y pro-Mía son recursos con una clara intencionalidad de contactar con personas que padecen un TCA o están en riesgo, con el fin de reforzar la comunicación entre ellas a través de la blogosfera.

["Pro Ana": Psychodynamic References for Anorexia Nervosa]. / "Pro Ana": Hinweise für ein psychodynamisches Störungsverständnis von Anorexia nervosa.

"Pro Ana": Psychodynamic References for Anorexia Nervosa The internet-based phenomenon "Pro Ana" refers to the eating disorder anorexia nervosa in a positive way. To understand what the phenomenon "Pro Ana" represents, the websites are used as a starting point of the current analysis. Based on these results, similarities and differences between "Pro Ana" and the eating disorder anorexia nervosa are discussed. Furthermore psychodynamic references for anorexia nervosa are derived and finally their importance for treatment motivation will be considered.

Experiences of using pro-eating disorder websites: a qualitative study with service users in NHS eating disorder services.

PURPOSE: Previous research into the impact of pro-eating disorder (pro-ED) websites has predominantly been undertaken using experimental and survey designs. Studies have used both clinical and non-clinical (college student) samples. The present study aimed to explore the underlying functions and processes related to the access and continued use of pro-ED websites within a clinical eating disorder population using a qualitative research design. METHODS: Participants were recruited through NHS community mental health teams and specialist eating disorder services within South Wales, UK. Face-to-face semi-structured interviews were conducted with seven adult women in treatment for an eating disorder who had disclosed current or historic use of pro-ED websites. Interviewees ranged in age from 20 to 40 years (M = 31.2; SD = 7.8). Constructivist Grounded Theory was used to analyse interview transcripts. RESULTS: Five key themes were identified within the data, namely fear; ambivalence; social comparisons; shame; and pro-ED websites maintaining eating disordered behaviour. The pro-ED websites appeared to offer a sense of support, validation and reassurance to those in the midst of an eating disorder, whilst simultaneously reinforcing and maintaining eating disordered behaviour. CONCLUSION: Themes are discussed in relation to implications and recommendations for clinical practice. Limitations of the present study and suggestions for future research are also outlined.

A Meta-Analysis Examining the Influence of Pro-Eating Disorder Websites on Body Image and Eating Pathology.

Previous research has indicated that exposure to pro-eating disorder websites might increase eating pathology; however, the magnitude of this effect is unknown. This study aimed to conduct a systematic review and meta-analysis to examine the effect of exposure to pro-eating disorder websites on body image and eating pathology. Studies examining the relationship between exposure to pro-eating disorder websites and eating pathology-related outcomes were included. The systematic review identified nine studies. Findings revealed significant effect sizes of exposure to pro-eating disorder websites on body image dissatisfaction (five studies), d = .41, p = .003; dieting (six studies), d = .68, p < .001, and negative affect (three studies), d = 1.00, p < .001. No effect emerged for bulimic symptoms (four studies), d = .22, p = .73. Findings confirmed the effect of pro-eating disorder websites on body image and eating pathology, highlighting the need for enforceable regulation of these websites.

"Glass fairies" and "bone children": adolescents and young adults with anorexia nervosa show positive reactions towards extremely emaciated body pictures measured by the startle reflex paradigm.

In this study, we investigated the emotional processing of extremely emaciated body cues in adolescents and young adults with (n = 36) and without (n = 36) anorexia nervosa (AN), introducing a new picture type, which was taken from websites that promote extreme thinness and is targeted specifically at adolescents interested in extreme thinness. A startle reflex paradigm was used for implicit reactions, while a self-assessment instrument was used for subjective responses. We found a significant group difference with a startle inhibition (appetitive response) among the patients and a startle potentiation (aversive response) among the controls, whereas no such difference for subjective measures was found. The results are in contrast to previous studies, which proposed a general failure to activate the appetitive motivational system in AN, but in keeping with findings from other addictions, where the same response pattern has been found. Implications for prevention and therapy are discussed.