Posting everything down to the bone

You open your screen to a blurry photo of an emaciated body from shoulders to knees. You are drawn to the tie of the strings on the little cotton shorts she wears. The strings are tied tight, and yet the shorts still hang below her protruding hips.

“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,” the creed reads next to the picture. All in white on a black page.

Welcome to the dark, and some would say sinister, world of pro-anorexia sites. Pro-anorexia, more commonly known as pro-ana, are communities developed on social media platforms. These communities allow individuals struggling with eating disorders to share experiences, goal weights, and motivation.

On everywhere from Blogger, to Twitter, to Tumblr, to Instagram, pro-ana content can be found. A picture on Tumblr of the "Holy Trinity" - tea, water, and diet coke - gets about 6000 likes and almost 2500 reposts. A low-calorie tip to replace pasta with zucchini receives about 7,000 likes. On Instagram the hashtag thin has been used 2.8 million times and the hashtag skinny 7.4 million times.

For the one million Canadians who live with an eating disorder, according to a 2016 StatCan study, such sites can exert a powerful influence.

According to a 2014 Ipsos Reid opinion poll, 91 per cent of Canadians said they agreed that “the media pressures to have a ‘perfect body’ are [one factor] to blame for developing an eating disorder.”

Worse, the heaviest users of social media are young people between the ages of eight and 20 – the same demographic that is most at risk for developing an eating disorder, according to Tim Simboli, executive director of CAMH.

And yet, surprisingly, a growing number of mental health experts and Canadians recovering from eating disorders say social media can also be a force for good in combating eating disorders.

Nicole Schott, a PhD student at the University of Toronto, authored a study in 2015 that contests the evils of pro-ana sites.

Schott describes pro-ana sites as an online support system for those with eating disorders.

“A lot of these girls actually recognize that they have a mental illness, but they are not finding that treatment is helpful, and they’re using this as an alternative method,” she told CBC’s Anna Maria Tremonti in 2015.

Schott said the sites allow for those suffering to feel accepted in a community, which can break stigma surrounding talking about mental health issues. In addition, she said it allows for individuals to reach for moral support from someone experiencing the same thing.

‘Ana buddies’ are a defining feature of these sites. Users look for an ‘ana buddy’ – a friend who also has an eating disorder - who will hold them accountable to their weight loss goals.

Schott’s study cites the example of one girl whose life was saved by her ‘ana buddy’ who called the police when she told the buddy was going to commit suicide.

Schott said the most common users on these sites are young women aged 12 to 20.

Lianne Kersten said she was 13, and diagnosed with an unspecified eating disorder, when she first came across a pro-ana site. She said the site provided her with the first information she was given about her eating disorder – this information was negative.

Young and naive, Kersten said the sites contributed to a downward spiral.

“I remember there was a special topic for exchanging tips on how you could purge the most successfully,” Kersten recalled. The site provided her with practical tips on how to hide her eating disorder, she said.

Such sites can be rife with misinformation and the kind of support they offer is not what people with eating disorders need, said Paul Garfinkel, a staff psychiatrist at CAMH and a psychiatry professor at U of T.

“You can’t teach new ways of vomiting, and say this is helpful,” said Garfinkel, adding that pro-ana sites also encourage people to deny that they have a serious illness.

It’s not just the words that can cause harm on pro-ana sites. Graphic imagery of skin and bones can trigger a vulnerable individual to take their eating disorder even further – with devastating results in some cases.

Last year, Instagram banned the posting of graphic self-harm images, cartoons and drawings. This was two years after allegations that exposure to self-harm content led British teenager Molly Russel to take her own life.

Tumblr and Pinterest had already made similar moves in 2012.

Should all social medias banish pro-ana sites? Kersten doesn’t think that would work

“I think it [a solution] should be found more outside of the apps,” said Kersten. “This community will find a way [to connect] anyway.”

Simboli also said regulation is not the answer. Instead, he recommended showing people how to use social media in a positive way

“Teach people how to be good consumers of social media,” Simboli suggested. “[Teach them] how to know what’s helpful and what’s not helpful and build the skills of the people who are using social media.”

Martina Mariglia, a registered psychotherapist in Niagara, Ont. who specializes in eating disorders, said she encourages her patients to unfollow accounts portraying diet culture and other harmful messages and to follow more accounts promoting body positivity.

“They [the methods] sound simple in terms of following and unfollowing different types of accounts but really they do make a big difference to what we are exposed to daily,” she said.

Mariglia urges her patients to follow ‘pro-recovery’ sites that offer support and advice to people trying to combat an eating disorder.

Pro-recovery sites often display an internal conflict between the desire to engage in disordered eating behaviours and the desire to recover, according to research published in the US National Library of Medicine in 2017. Seeing how the creators of these sites overcome this internal conflict can be beneficial to others working towards recovery.

Erin Morrissey, 27, is a full-time blogger living in Philadelphia.

She said she began her blog “Erin Lives Whole” in 2017 with the intention of posting recipes, a passion of hers, but then realized she had a bigger story to tell.

Morrisey said she developed an eating disorder in her second year of university. She said she went from not giving a thought to what she ate, to controlling her diet to the point where she only ate what society deems ‘healthy foods’- a disorder called orthorexia. Morrissey said she was officially diagnosed with anorexia.

“Once I started sharing more and more, I had so many people reaching out to me saying ‘That also happened to me’ or ‘I’m ashamed to tell my friends that this happened to me’ or ‘I need help and I’m afraid to tell people that I need help,’” said Morrissey.

Simboli said he sees the rationale for people with similar issues sharing support on social media outlets. However, he urges that peers should be used only for emotional support, not professional advice.

Garfinkel also said such sites can help people with eating disorders overcome the sense of isolation that many feel. The upside of social media is that “for somebody who’s isolated, support, understanding and connecting are highly valued”, he said.

Morrissey said she is very cautious about the language she uses in her posts to ensure nothing is triggering.

“I never want to say ‘This is low-calorie, healthy …’ I do absolutely none of that,” she said.

She said she also makes a point to share that she eats everyday foods like pizza.

“I find that by sharing both, it shows that I’m a human and I don’t live a perfectly ‘healthy’ life. And I think that’s very beneficial for my audience to see,” she added.

Individuals can look up to recovery bloggers as role models.

Morrissey said she ahs received multiple direct messages from one girl over the three years her blog has been active. She said she ended up meeting the girl who went through a full recovery process and they are now good friends.

“It’s just the feeling that I’m lifting people up and and inspiring them and that there is hope for recovery,” she explained.

Mariglia said social media has power that can be used positively or negatively.

For Morrissey, the positive aspect is crucial.

“I feel like I have a lot of [followers] who feel lightened up by my content,” said Morrissey.

“If you choose to fill your feed with things that make you happy then you can really use it in a way that benefits you.”