Nurturing an Anorexia Obsession

At first, peering into her computer screen, Janice Saunders was struck by the eerie triptychs: jutting hipbones, a blade of clavicle, a rib cage in relief.

A double click brought her to message boards full of wild chatter and ghoulish advice: “Worried about that side of fries last night? Swallow half a bottle of laxatives!” “At a plateau? Try syrup of ipecac, what they use at hospitals for accidental poisoning. This helps to purge the body.”

With each left-click, each move of the mouse, a murky world came more clearly into focus.

“It is so great to feel lean and pure and clean. Thats why I’m promoting Anorexia, although I don’t think it should be labeled a ‘disease.’ It’s not like that. Ana gives comfort, control, beauty. Everything that a girl could ask for.”

Pro-anorexia? Anorexia as a desirable choice? At first, she says, still sounding a bit bewildered, “I thought it was a joke. I thought I was misreading.”

But as she explored, Saunders, who has been running her own Web site, Support Concern and Resources for Eating Disorders, or SCARED, out of her home in London, Ontario, found scores of pro-anorexia--”pro-ana”--sites. Deeply disturbing pages aimed at anorexics and bulimics were filled with tips on how to protect tooth enamel from frequent episodes of purging, 2 a.m. “no-excuses” exercise regimes and photos that flaunted a death-camp aesthetic of skin and bones.

Her early explorations became a vigil. Every day she gets up at 4:30 a.m. and goes to her computer to track the activity on her site--and the others. The voices haunt her. “I live with Mia, but Ana comes to visit occasionally, “ says one posting. “I no longer hide Ana from anyone,” confesses another.

“Now I hate Mia and I want Ana more than anything.”

“Mia”--bulimia nervosa--and “Ana”--anorexia nervosa--are the two most tenacious eating disorders. Once, many anorexics and bulimics tended to isolate themselves, say experts who have been helping clients wrestle with these complex conditions for decades. But as Saunders discovered, that is beginning to change. Within the fluid anonymity of the Internet, a new generation has made its eating disorders a unifying badge and, ultimately, a way to bond in a dangerous pursuit.

“They see this as something [to be] cherished,” Saunders explains. “They tell one another that it is going to give them happiness: It’s a place where they can make friends.”

In this realm, “support” or “advice” doesn’t mean referrals to doctor’s care or tips for recovery. Rather, the hundred or so Web logs--or blogs--loops, diaries and online pro-ana communities nurture their visitors’ consuming obsession with extreme thinness.

One click away from the “Thin Commandments” is the “Ana Creed”: “I believe in Control, the only force mighty enough to bring order to the chaos that is my world.” And just a hyperlink away from that are rated lists of “recommended” over-the-counter diet pills, supplements and laxatives. The sites, say eating-disorder experts, pose grave dangers to their most vulnerable visitors and a new set of roadblocks to those who try desperately to treat them.

“Anorexics tend to be a competitive bunch,” says Jenn Berman, a Beverly Hills-based therapist who daily sees the eating disorders that take hold arise in the driven athletes and actresses she treats. “So reading that someone lost X amount of pounds just ups their activities. It’s one of the reasons that group therapy isn’t recommended. Anorexics try to outdo each other--in illness, not in success.”

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The pro-ana community is well-known to those who work with anorexics and bulimics. Saunders heard about it when a young girl battling an eating disorder visited her SCARED page and told her about the sites she had run into en route. Saunders was immediately concerned because she knew how powerfully women are drawn to the Internet as they seek self-help tips.

Five years ago, she had launched a Web page to help herself deal with depression and offer a forum to others and was surprised to see how many of her regular visitors sought help with eating disorders. SCARED evolved to support them.

Saunders wanted to see the new pro-ana sites for herself. She took to sitting on a few mailing lists, using names such as SkinnyMini. And in no time she began receiving daily e-mail reminders: “Remember. Do not eat today.” Or a nudge to recite one of the Thin Commandments: “Thou shall not look at food.”

She jumped in with counter-arguments--sometimes riling others enough to get kicked out of various rooms and lists. Then, last year, she began running across postings that pushed her beyond chat room spats. “One of the girls,” she recalls, “was telling girls to cut off the fat off their bodies with a serrated knife! Take a pile of laxatives!’”

The mother of four daughters in their early to mid-teens, she asked herself: “Do I want [them] to read this? There are girls who are spending their money and busting their butts to get help, and this is what they are coming across.”

Saunders contacted Internet service providers, demanding that the sites be shut down for offering content that harms minors. No response. Eventually, though, her protests, along with those of others who had begun to informally organize on her site, got attention. Last summer, Saunders returned from a vacation to find her online mailbox overflowing with messages, their subject lines rejoicing: “We won!” or “Congratulations! They’ve closed the sites!’ I thought, ‘Oh my God! That’s great!’”

But in just a few short weeks, the pro-ana pages were back--all over the Internet.

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Again and again, under slightly altered names or camouflaged by coded keywords, these sites and their Webmasters rebuild and resurface, sometimes slightly disguised, but each time more emboldened. “They are fighting a losing battle,” one Webmaster recently wrote. “I will just keep showing up.”

In the United States, the battle was joined by such health care professionals as Holly Hoff, director of programs for the National Eating Disorders Assn., based in Seattle. Her organization’s efforts paralleled Saunders’, as her group sent letters to Yahoo and other service providers that were hosting the sites. Yahoo took note in August and was the first to begin closing pro-ana sites and clubs, citing their harmful or threatening content. Other service providers followed suit. But again, the sites reemerged elsewhere.

Many eating-disorders specialists see shadings of their patients’ complex profile in the Webmasters’ tenacity.

Frequently, says Hoff, anorexics and bulimics “tend to be women who are perfectionists, goal-achieving. They are the good students, the good child, the good mate, the good friend.” So the doggedness fits the profile.

“These sites illustrate an extreme representation of the illness,” says Margo Maine, a Connecticut-based therapist and author of “Body Wars: Making Peace With Women’s Bodies” (Gurze Books, 1999). “More than just a diagnosis, it becomes their total identity, this badge of illness.”

Extremely Ana, Tiny Dancer, Stick Figures, Only Popular W/Anorexia, Wanna B Skinny, Thinspiration and Dying for Perfection are just a few Web sites that have recently been shuttered or slipped from plain sight. Of the sites that remain, some are zine-like blogs with a tumble of busy graphics that recall inky notebook doodlings or hasty post-punk cut-and-paste locker collages. Others are crowded chat rooms or hyperlinked Web rings. Compulsion, and a desperate, unattainable desire for control, are everywhere.

“I ate 780 calories the other day and I still feel like I want to die, (I wrote ‘fat pig’ on my left leg in marker, that seemed to help a bit), so I went home and went running at 2:30 a.m. About 7 miles I try to maintain a sense of balance.”

With their misspellings, muddy graphics or stream-of-consciousness entries, some of these sites may look amateurish--even harmless. But therapists are already seeing alarming evidence of their effects. Their casual tone and imperfections, like a voice of a friend, are, in fact, their power.

And that easy intimacy drowns out the concerns of friends, therapists and families in the minds of those with eating disorders.

“Right away you see the skepticism,” says therapist Berman, bent over the laptop propped open on her office desk, a page open to Friday night action on one pro-ana site. The boards are alive; postings arrive every few minutes. Their hyperactivity, says Berman, is part of the compulsive profile: Some posts flame a TV drama’s depiction of bulimia--sight unseen. Others complain about doctor visits or stew over a concerned husband’s attempt to force a meal--”at least a chicken nugget.””There’s a real we-versus-them aspect,” Berman says. “But all these people want to be thin as opposed to being well.”

Indeed, the sites paint “Ana as lifestyle” in vivid brushstrokes: Waif as elegant aesthetic; willpower as mark of strong character.

This sort of argument marks the first phase of the illness, says Ali Borden, primary therapist at the Monte Nido Treatment Center in Calabasas. “When they start in on an eating disorder,” says Borden, “they are completely unaware of the effects. They think that they will be thin, loved, successful, popular--which seems to be the stage that the people running the sites are totally locked in. But suddenly they realize: I feel tired, I’m not seeing my friends anymore, I feel weak, I feel sick. But then they think: Well that must mean I’m not working hard enough. I need to work harder.”

As they do, they face realities of a body deprived of food. Hair thins. Bones snap. Organs give out.

An estimated 5 million to 10 million American women in post-puberty struggle with some form of eating disorder, says Hoff. And without intervention, Berman notes, anorexia has the highest fatality rate in the DSM-IV, the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Assn. That’s what these sites often gloss over, stresses Berman. “People die from this disease,” she says. “They die.”

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“Sharon,” a pro-ana Webmaster, created her site as a refuge from the rub of criticism, the prying questions about her weight and size. Her pages are understated, almost elegant. She says she spends “too many” hours a day tending to them, coordinating a full roster of forums--from fasting and pills to women with families (“How do you balance ana and family life?”).

In the mid-’90s, she says, she was 16, discovering the Internet--and obsessed with thinness. “I put up my first page about the beauty of starvation,” she says, and mail piled in, both hateful and kind. “I was quite proud of myself causing such a stir!”

“But my interest in this has gone beyond being provocative,” she explains. “My original goal ... was to bring the issue of eating disorders to the forefront by making a site that was ‘borderline.’ Where do diets end and anorexia and bulimia begin?

“I think the line is blurry,” she says. “In women’s mags you see an article about the horrors of pro anorexia, or some ballet dancer who died of an ED right next to ads for fad diets and bone-thin models. I felt that I was receiving a mixed message from the world around me, so I decided to send one right back.”

Experts don’t disagree with “Sharon” about the conflicting signals sent to women. “When I begin therapy,” Maine says, “I tell patients, ‘Our society is like living in a cult, and I’m going to have to deprogram you.’”

A wisp of an Olympic star or blade-thin runway model offered up as symbols of success in one corner of the culture are likely to turn up as well on sites like “Sharon’s.” Some pro-ana pages are festooned with graphics of the Kate Mosses or Calista Flockharts of the moment, scanned from fan or glamour magazines. Others might be interspersed with anonymous photos of skeletal girls and women--miming the provocative poses of their idols. Such images (as well as affirmations, rules and revelations) are referred to as “triggers”--inspiration to help extreme dieters stay the course. “Hunger hurts, but starvation works!”

Victoria Jackson understands the power of triggers. Now 20, the University of North Carolina student has wrestled with anorexia since 9. “Being anorexic is really hard, and it takes a ton of self-control and willpower,” Jackson says. A message or picture on a Web site, she suggests, “isn’t strong enough to convince a mind to do something so demanding. I really think that the decision is already made. But the Web sites are like a morale booster, something to keep you going, to make things easier.”

When she looks at the sites at a reporter’s request, she remembers the rush that used to accompany a new discovery, a new technique for staying in control of her weight. “A drink that has no calories ... [or] a ... new trick to stop hunger pains,” she explains, felt like a new chance. “You are going against what your body is telling you. If you’re really hungry, that’s hard to fight, so new ways to make it easier are embraced. It’s just one more thing to be absorbed in. One more thing to drive you, one more tool.

“I’m past all of that,” Jackson says, “but even looking at [a site] really upsets me. It’s really going to add to people’s problems.”

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While some patients are horrified by the sites and immediately alert their therapists, others don’t always let on that they’ve made visits, says Maine, “but you figure it out.” The sites “just reinforce every pathological thought. Some sites tell what to wear. How to mask your lag [in gaining weight]: Weights, shoes under your arms. Eating olives and pickles, water loading. There’s a science to it.”

At the same time, she adds, they provide fuel for denial. “A lot of these patients will look at these sites and say: “Well, I’ve never been that skinny!’ or I’ve not been to the hospital three times. So I’m not really an anorexic. That’s just part of the whole web of illogical thinking.”

Specialists such as Maine felt their patients pulling away as they spent more time on the sites, but they were reluctant to lead public battles to get pro-ana material off the Internet. “We were worried we’d lead [patients] there,” Maine says. So last year, before they turned to the Internet service providers, Hoff and other specialists tried contacting the Webmasters directly.

“We made appeals about their own health and well-being,” Hoff says. “We reminded them about their potential for harm. Unfortunately, we didn’t have much luck. They felt that it was their right. That people visit at their own risk. Many of them feel that they are martyrs.”

They hang on, tenacious.

So does Janice Saunders.

After her success last summer, she was flamed with angry e-mail, pelted with profanity, taunted and threatened. But there have been sweet surprises.

She played a particularly vigorous game of cat and mouse with an angry Webmaster, whose site was shut down, then resurfaced and was shut down again. It reappeared yet again, but this time, it had changed.

“What are you here for?” the site’s most recent version now asked visitors. “What do you hope to find?”

What followed was a sober renunciation and apology that gave Saunders pause. “I am now very grateful to Yahoo for removing my Web site, twice. I was absolutely devastated and angry at the time, now I am very grateful and fully supportive of them. Please reach out. You don’t have to be lonely or hurting anymore.”

Saunders was stunned, and revitalized. “I can’t remove every Web site,” she says. “But I think if it changes one thing ... it’s well worth it. Because too often, I’ll ask, ‘Where’s so and so?’ They’re gone from the lists, the chat rooms. Sometimes there is no answer. They don’t know what happened. Some girls just disappear.”