Although it is not possible to say that the use of such sites exacerbated the disorders, persons who do access the sites report that they learn new techniques for dieting and attempted weight loss. Some of these techniques are pathological.
Surfing for Thinness: A Pilot Study of Pro–Eating Disorder Web Site Usage in Adolescents With Eating Disorders
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1635-e1643 (doi:10.1542/peds.2006-1133)
Jenny L. Wilson, BA, Rebecka Peebles, MD, Kristina K. Hardy, PhD, and Iris F. Litt, MD
OBJECTIVE. Pro–eating disorder Web sites are communities of individuals who engage in disordered eating and use the Internet to discuss their activities. Pro-recovery sites, which are less numerous, express a recovery-oriented perspective. This pilot study investigated the awareness and usage of pro–eating disorder Web sites among adolescents with eating disorders and their parents and explored associations with health and quality of life.
PATIENTS AND METHODS. This was a cross-sectional study of 698 families of patients (aged 10–22 years) diagnosed with an eating disorder at Stanford between 1997 and 2004. Anonymous surveys were mailed and offered in clinic. Survey content included questions about disease severity, health outcomes, Web site usage, and parental knowledge of eating disorder Web site usage.
RESULTS. Surveys were returned by 182 individuals: 76 patients and 106 parents. Parents frequently (52.8%) were aware of pro–eating disorder sites, but an equal number did not know whether their child visited these sites, and only 27.6% had discussed them with their child. Most (62.5%) parents, however, did not know about pro-recovery sites. Forty-one percent of patients visited pro-recovery sites, 35.5% visited pro–eating disorder sites, 25.0% visited both, and 48.7% visited neither. While visiting pro–eating disorder sites, 96.0% reported learning new weight loss or purging techniques. However, 46.4% of pro-recovery site visitors also learned new techniques. Pro–eating disorder site users did not differ from nonusers in health outcomes but reported spending less time on school or schoolwork and had a longer duration of illness. Users of both pro–eating disorder and pro-recovery sites were hospitalized more than users of neither site.
CONCLUSIONS. Pro–eating disorder site usage was prevalent among adolescents with eating disorders, yet parents had little knowledge of this. Although use of these sites was not associated with other health outcomes, usage may have a negative impact on quality of life and result in adolescents’ learning about and adopting disordered eating behaviors.
This is not really surprising. Probably it is not a causal thing. Persons who are in more distress, and who have less support from actual humans (for whatever reason) seem more likely to use the Internet to seek help. This these are risk factors for more serious conditions. Also, without a professional moderator, it is very easy for persons with eating disorders to become competitive with each other. That competitiveness leads to a sense of urgency, which increases the motivation for weight loss at any cost.
Further reading: David Earl Johnson, MSW, LICSW, has a nice review of the subject on his blog, Dare to Dream. Shelly Batts, writing on Retrospectable, recently had an interesting post, followed by a long discussion in the comments. A news report of the Pediatrics study can be found at Daily News Central. Another review can be found at Newsweek. They mention the following comment:
In November, the Academy for Eating Disorders suggested a mandatory warning statement: "Warning: anorexia nervosa is a potentially deadly illness. The site you are about to enter provides material that may be detrimental to your health."
That would be a responsible thing to do, but it is hard to see how it could be enforced.
Comments
My wife volunteers for the Eating Disorder Coalition of Tennessee. We have a friend who works there who is a former Miss Indiana (I think), and who was the second runner up that year for Miss America. And who, as nobody will be surprised, struggled with eating disorders.
The EDCT has a speakers' bureau, where they train people (mostly health professionals) in giving talks on the matter. Our friend talks about how once upon a time, she was on the "former beauty queen recovering from an eating disorder" lecture circuit, where she'd go and tell young women and girls how bad it had gotten and how she got out of it. But, she said, the effect was that girls in the audience would listen more closely to the techniques and self-deceptions she used to further her eating disorder. She came to realize over time that untrained people giving self-revelatory talks about their own struggle is not the right way to approach the problem.
Even when you're pro-recovery, it can be tricky to do it right.
-Rob
Posted by: Rob Knop | December 11, 2006 11:09 AM
Exactly so. It is similar to the situation I've seen in some substance abuse recovery centers, where it is easy for groups to go off on countertherapeutic tangents about their "war stories" of their drinking episodes. Although they are not consciously trying to undermine anyone's treatment, it does have that effect. What's more, though, is the competitiveness that you sometimes see in persons with eating disorders. That is a difficult thing to manage, because it becomes such a central part of a person's identity.
Posted by: Joseph j7uy5 | December 11, 2006 6:03 PM
Not exactly the same thing, but there's also "ex-gay" groups - organisations like NARTH and Exodus International which try to make gay men straight through electroshock aversion, bible study and psychotherapy.
I spent a few months infiltrating them once for a research project, and I've never heard so many lip-smacking descriptions of "same sex sin" from self-hating christians. If you want to hear men wallow in lurid detailed descriptions of sodomy together, listen to groups trying to give it up.
Posted by: Kapitano | December 16, 2006 3:57 AM
This is a new site aimed toward providing community support while promoting recovery from an eating disorder. Please check it out and add your thoughts!
Posted by: Kristine Tippen | January 27, 2009 10:35 AM