About 0.5 to 3.7 percent of women suffer from anorexia in their lifetimes, according to the National Institute of Mental Health (NIMH). About 1 to 4 percent are bulimic. NIMH estimates that about 2 to 5 percent of Americans experience binge eating disorder (characterized by excessive eating that occurs, on average, at least two days a week in a six-month period).
Those with eating disorders exhibit serious disturbances in eating behavior and feelings of extreme concern about body shape or weight, the NIMH says. Researchers are investigating how voluntary behaviors, such as eating different sizes of food portions, at some point develop into an eating disorder. Experts agree that eating disorders are not due to a failure of will but are treatable medical illnesses.
Alison Devenny, 19, visited pro-eating disorder Web sites regularly until seeking treatment three months ago.
(Andrea Bruce Woodall - The Washington Post)
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Eating disorders are often accompanied by depression, substance abuse and anxiety disorders. Common personality characteristics include excessive anxiety, perfectionism and low self esteem. Treatments include hospitalization or outpatient treatment, as well as psychotherapy, nutritional counseling, cognitive therapy, behavioral therapy and antidepressant medication, according to the Harvard Eating Disorders Center.
About half of people with anorexia or bulimia recover completely through treatment, according to the Harvard center. About 30 percent make a partial recovery, and 20 percent have no substantial improvement. The mortality rate for anorexia is about 5.6 percent per decade, according to NIMH. Cardiac arrest and suicide are common causes of death for anorexics. But "Anas" and "Mias" say they are not sick, don't need to be "fixed" and don't want sympathy. They develop creeds and post poetry and online diaries reciting their beliefs. They applaud one other for reaching low weights. Their message board conversations often turn to statistics: height, weight, measurements.
A site called Blue Dragon Fly sells red bracelets to encourage "solidarity" among pro-anas. "So you can go out into the world and not have to wonder, 'Is she or isn't she?' . . . You see the red bracelet, and you know," the site explains.
But it's the pro-eating disorder advice that many women say they seek on these sites. There are tips for the best foods to eat and vomit up later ("remember if it is hard to swallow it will be hard to 'unswallow,'" one site says) and how to cover up your eating disorder (tell friends and family you're sick or have already eaten, tips another site). A college sophomore from Alexandria diagnosed with bulimia and anorexia said tips from pro-eating disorder sites helped her go from 161 pounds to her current 74 pounds.
"At times I did gain back the weight, but I would always make a plea for help on the pro-ana" Web sites, she wrote in an e-mail responding to a reporter's question. She asked not to be identified by name, adding that although her family knows she has an eating disorder, they don't know -- and wouldn't approve of -- her visiting these sites. She called the sites "a tether to bring me back on track when I start to think about going into rehab or bingeing without purging."
Some Internet service providers shut the sites down in 2001 after the nonprofit National Eating Disorders Association (NEDA) and other groups complained that the sites contained content that could harm minors. Many sites disappeared briefly, only to reemerge later under different names and on different Internet domains.
Seattle-based NEDA has since changed strategies, opting to create increased awareness and education about eating disorders on the Web and elsewhere.
"There's the whole free speech issue" in trying to have sites removed from the Web, said NEDA chief executive officer Lynn Grefe. Unless sites encourage or reflect specific crimes, most Internet service providers have been reluctant to shut them down.
