Web sites offer 'blueprint' for anorexia

DENVER — With hundreds of Web sites giving girls tips on starvation diets and featuring pictures of stick-thin celebrities as inspiration, a "pro-anorexia" movement is flourishing on the Internet and inspiring deep concern among medical professionals who worry that it glamorizes a deadly illness.

Led largely by defiant young women who deny anything is wrong with them, this underground movement revolves around the idea that anorexia — a disorder that causes girls to starve themselves — should be embraced and even promoted.

The notion appalls physicians and psychologists, who note that more than one out of 10 people diagnosed with anorexia ends up dying — half from suicide, half from organ failure or other medical complications.

"I thought, my God, what is this? I couldn't believe what I was seeing," said Daniel le Grange, director of the eating-disorders program at the University of Chicago School of Medicine, who has reviewed various pro-anorexia sites.

"Patients who don't understand the full extent of their illness, that's nothing new," le Grange said. "Girls who cherish their symptoms, that's nothing new. But bonding together to teach people over the Internet how to become better anorexics, I've never come across anything like this before."

While most support groups try to help people recover from addiction or illness, these pro-anorexia supporters cling to their unwillingness to eat, in the face of opposition from family, friends and doctors. What's more, they celebrate their condition.

"This is a place for people who realize that ana is a lifestyle and a decision, not an 'illness' to be fixed," wrote the founder of the Proanasanctuary club on Yahoo. "For people who are/want to be anorexic," announces another Yahoo site, Proanorexia.

"M," a 15-year-old girl from Ohio, said she visits pro-anorexia sites when she's feeling hungry or depressed. "I sign on and see how everyone is. ... They are the only people who really understand," she said in an interview.

"I don't see anorexia like the doctors do. It's just the way I live. I don't see now how I could go back to living any other way," added M. She first became anorexic in sixth grade and admitted she is hiding the condition from her parents.

Asked if she's worried about becoming dangerously thin, she said, "My friends and I don't want to die. We tell each other all the time, don't get too carried away with it. I feel very in control, and that's one of the reasons I like it so much. There are probably people who are out of control, but not me."

Chat rooms linked to pro-anorexia sites are filled with girls sharing tips on how to lose weight, hiding food from their parents, controlling their binging and using diet pills or laxatives. Some sites also feature startling photographs of nude young women whose ribs are barely covered by scant flesh.

About 5 million people in the United States, most of them teenage girls, have anorexia, a psychological condition closely associated with low self-esteem, intense perfectionism and a pressing need for control. At least 1,000 people diagnosed with anorexia die each year.

"This is one of the most deadly diseases out there," said Dr. Ted Weltzin, medical director of the eating-disorders program at Rogers Memorial Hospital in Oconomowoc, Wis.

"These Web sites that ... are almost blueprints on how to become a better anorexic, are not something these people need."

Anorexia is one of the most notoriously difficult psychological illnesses to treat because "girls strive to hold onto it. It's their identity," said Ellen Astrachan-Fletcher, director of the eating-disorders clinic at the University of Illinois College of Medicine in Chicago.

"An alcoholic, once they admit their alcoholism, typically acknowledges this is a bad thing, I need to get into treatment. With anorexia, these girls say: Look at how much self-control I have, ... look at what I'm accomplishing."

At one Web site, an 18-year-old college freshman celebrated the return of her anorexia, after a period of recovery.

"My most happy and successful memories are from when I was a successful anoretic," she wrote. "When I was in my peak anoretic phase, I dropped 60 lbs. In three months! God, I want to be there again ... I want to be empty and clean and free again ... So, thankfully, ana has re-entered my life."

Like many sites, the freshman warned visitors that they should not enter if they have an eating disorder and are in recovery.

The warnings seem to be evidence these Web authors know the sites can be dangerous, experts said. But deep ambivalence about the danger, a prominent characteristic of anorexia, is common.

"When a patient is in the process of struggling with an eating disorder, they reach a point of deep ambivalence," said Astrachan-Fletcher. "In therapy, people often say, `I feel I have an angel on one shoulder, and a devil on another. The angel is getting well, the devil is staying sick.' These sites support the devil."