Pro-Anorexia on the Internet, should it be banned?

In my current clinical job I work with people who have eating disorders. Generally this is anorexia and—as we provide inpatient care—the people we see are often at the severe end of the scale. 

One of the issues that comes up regularly with patients, families and fellow professionals is the degree to which the media and society cause or perpetuate this condition with the images they portray of size 0 models. This is a debate and an issue many of us will be aware of but less well known to people may be the issue of 'ProAna'. 

If you Google anorexia you will find a variety of resources looking to inform people about the condition, its risks, provide support for recovery or how to access treatment. Search 'proana' however and the message is far different.

If you take a look at some of these sites you will generally notice a message on the home page about support and recovery for people with eating disorders. This is often to avoid being removed by their host or as a disclaimer. The content reflects a different view. 

The sites usually contain hints and tips on reaching very low weight and concealing your eating disorder. The blogs contain people's weight loss goals with others offering support and encouragement to reach again dangerously low weights. Photos of very thin people—usually women—are used as 'Thinspiration'.

Here's a selection of tips which are clearly not recovery focused.

  1. Use small, dark coloured plates. Dark blue or black makes you eat less, and smaller plates and utensils cause you to take smaller portions from the start.
  2. Make a list of “bad” foods. Periodically, cross one of the list and pledge to never, ever eat it again. Eventually there will be none left.
  3. Eat in front of a mirror, naked or in underwear if possible. If you can’t, carry a picture of yourself in a revealing outfit and look at it when you want to eat. When you have cravings pinch your fat and look at your problem areas, don’t add to them!

Unsurprisingly most organisations who work towards recovery criticise the sites and most call for them to be banned. There is some recognition that the sites provide a support network for a group of people who feel desperate and alone. There is some evidence of a negative impact but obviously this a difficult area to research.

Two major organisations in the UK differ in their view. The Royal College of Psychiatrists calls for them to be banned due to the risks they pose. b-eat The Eating Disorder Association for the UK doesn't stating that rather than remove them we should seek to draw people away by offering alternate avenues of support.

I was recently put on the spot on this very issue. Presumably every expert in the UK in eating disorders was busy so I got a call from the Sun newspaper on the issue of Proana sites. I gave the consensus view as regards their, in my view, negative impact and at times dangerous content. The journalist then asked me if they should be banned.

Unusually for me I didn't say the first thing that flashed into my mind ie 'YES'. As with so many things there is I think more complexity to this than at first sight. 

Firstly as a psychiatrist I am innately cautious about making pronouncements from authority about issues of civil liberty. Psychiatry does not have a particularly good record on this one. Secondly as a doctor I would want to see a higher level of evidence before such sites were banned on 'medical' grounds. 

My view—and what I told the reporter—was that I thought that the decision to ban or not was for society to make based on peoples take on a number of issues.

Even internally my views are mixed. My medical opinion is they probably should be banned, but my personal view is generally anti-censorship and my practical view is that if we can't stop child pornography, bomb making and drug production sites there's not much chance of resources going into tracking and removing pro-anorexia sites.

Having given it more thought I tend to agree with b-eat. What limited resources we have to deal with this issue are better spent finding ways to engage and support people rather than in a doomed attempt to police the internet.