Will you be my friend? This question has been revolutionized by the advent of social media. Before, asking this question was fraught with vulnerability, immediate responses, and a greater sense of satisfaction when friendship was established. Now, one can ask this question with a click of a button, and no associated feelings of trepidation or anticipation. Social media, defined by Webster’s dictionary as, ‘forms of electronic communication through which users create online communities to share information, ideas, personal messages, and other content (for instance, videos),’ has recently permeated the interpersonal landscape of internet users internationally. Indeed, subscribers to the internet now typically have multiple social media accounts, allowing one to, quite literally, have their friends ‘at their fingertips.’ With a few keyboard strokes, we can check in on the marital, social, professional, and personal details of a long-lost ‘friend.’ What does it mean that social media may be changing our perception of friendship?
Some research has investigated how social media instills a false sense of intimacy and community, by allowing users to passively engage in a friendship through liking or browsing posts1, 2, 3. For those of us familiar with social media, we know that being a “friend” on Facebook requires a lot less effort than being a friend in ‘real life’. The most popular social media site, Facebook®, provides a count for each user’s “number of friends”: the more friends, the more popular you are! The average Facebook® user has 388 friends, though a recent study found that only 25% of these friends were reported as close friendships4. Not only is this percentage only a fraction of the originally reported 388 friends, claiming such a large number of close friends may in fact indicate that even our definitions of friendships are altering with the increased use of social media. Thus, it is necessary to consider the role of social media for people struggling with eating disorders; disorders commonly associated by body image concerns and less commonly associated with identity confusion5 and loneliness6. Given these less-known features of eating disorders, social media has the potential to be particularly appealing in this population to abate real and perceived isolation. Unfortunately, social media can also be a dangerous platform for this population, connecting ill users with one another and promoting the exchange of disordered eating behavior.
Social Media for Eating Disorders: Pro-Eating Disorder Blogs
A new social media form has recently flourished, that has specific implications for eating disorders. Pro-eating disorder (pro-ED) online websites/blogs (‘pro-ana’ (pro-anorexia) or ‘pro-mia’ (pro-bulimia)) have developed a devoted underground following of curious users either actively ill with an eating disorder, in recovery, or not yet meeting clinical threshold. The average age of individuals who subscribe to pro-eating disordered (pro-ED) content on social media is 17 years old, a particularly vulnerable age-group susceptible to the influence of provocative disordered eating content presented on these blogs. While some research finds that viewership of pro-ED content can increase disordered eating behaviors (such as dieting and concern with one’s body shape and weight), other studies find that these blogs reduce levels of loneliness and help users feel greater levels of happiness7. For parents, patients, and clinicians, awareness of these blogs and their impact both emotionally and physiologically is important. Let’s discuss some examples of the harmful impact of participation in pro-eating disorder blogs.
“Ana [anorexia] must be the center of your life.” This is rule number two in a pro-eating disorder blog written by a sixteen-year-old self-proclaimed friend of ‘Ana’. This blog contains links to other (similar) eating disorder blogs promoting a particular lifestyle: a lifestyle that embraces ‘Ana’ (anorexia) and ‘Mia’ (bulimia). While this phenomenon is not widely researched, several pro-ED blogs purport a unique commonality: individuals with eating disorders often personify disorder as Ana or Mia, and frequently refer to these ‘friends’ when describing their disorder. They insist that Ana and Mia have their best interests (self-starvation and other eating disordered behavior) at heart. Indeed, several posts and discussion threads are seen dedicated to the alignment the bloggers have with their eating disorder persona. The following is titled “Ana Creed” and is displayed on several pro-eating disorder blogs:
“I believe that I am the most vile, worthless and useless person ever to have existed on this planet, and that I am totally unworthy of anyone’s time and attention. I believe that other people who tell me differently must be idiots. If they could see how I really am, then they would hate me almost as much as I do. I believe in oughts, musts and shoulds as unbreakable laws to determine my daily behavior. I believe in perfection and strive to attain it. I believe in calorie counters as the inspired word of god, and memorize them accordingly. I believe in bathroom scales as an indicator of my daily successes and failures. I believe in hell, because I sometimes think that I’m living in it. I believe in a wholly black and white world, the losing of weight, recrimination for sins, the abnegation of the body and a life ever fasting.”
This terrifying oath to ‘Ana’ demonstrates both the severity and rigidity associated with eating disorders, as well as the strikingly negative self-image. From a treatment perspective, this self-view and embracement of an eating disorder lifestyle is dangerous and maladaptive, particularly in motivating recovery.
The disturbance of identity in individuals with eating disorders is particularly concerning, given that a significant portion of pro-ED users are adolescents and young adults who are in the process of forming a concrete sense of self8. By casting eating disorders as a ‘lifestyle choice’ and an attractive option supported by other users, pro-ED content legitimizes these identities and can often minimize the severe physiological implications of eating disorders. Stripped of negative ramifications, these ‘eating disorder identities’ are all the more appealing to young, impressionable bloggers, who are in the midst of their identity formation. Research on the consequences of group dynamics and Internet communities has shown that people are far less likely to consider divergent views when they are continuously reinforced by other, similar minded group members. Not surprisingly, this is particularly true of pro-ED communities, who will often go to extremes to exclude users who they view as being unable to fully commit to their lifestyle. This reinforces the pro-ED mindset, and creates a dangerous in-group for users.
Pro-eating disorder websites are laden with triggering information, and offer dangerous weight loss behaviors and discussions of hiding these behaviors for users. Research has shown that exposure to pro-eating disorder sites results in increased eating pathology and greater identification with an eating disorder persona9,10. Triggering content (such as rigid, dangerous rules regarding eating) is repeatedly purported to help the individual become “better friends” with ‘Ana’ and ‘Mia’, thereby reinforcing a false sense of friendship and identity. For a population of individuals so desperate to create an identity and feel supported their unhealthy choices, pro-eating disorder blogs provide an ideal platform for networking with others going through the same struggle.
Are There Any Benefits?
Are there any objectively positive benefits to participating in pro-eating disorder blogs? Some research has, in fact, demonstrated that participation in pro-ED discussion forums has some positive consequences after use. For instance, one study found that a third of online users reported that online pro-ED blogs were ultimately helpful towards their recovery by helping them find support, understanding and amelioration of loneliness11. Another appealing aspect of online pro-ED blogs is that they provide individuals with the ability to post about their illness with no responding judgement or criticism12. Many bloggers have reported that they are able to establish friendships with others (either in recovery or actively ill) who are able to empathize with their experiences, rather than judge them for their choices. Considering that this population is characterized by loneliness and isolation from previously established friend groups, it is easy to see why pro-ED blogs and ‘friendship’ obtained by like-minded users is particularly alluring. These benefits are critical when considering the appeal these blogs have for individuals with eating disorders, and how future research can capitalize on these benefits while minimizing the discussed harmful consequences.
Conclusions: Raise Awareness
In summary, pro-eating disorder online content is obviously appealing to individuals with eating disorders, promising a safe space with other, similar users, and identification with one’s illness. This is incredibly potent for young adolescents searching for identity and community. Creating awareness of the ramifications and allure of pro-eating disorder websites is important amongst clinicians, parents, and patients alike. With the rising popularity and prevalence of pro-eating disorder blogs, it is critical to continue exploring the impact these social media sites have on individuals with eating disorders.
By Nandini Datta
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