The following is a research paper written for one of my classes at the University of California, Santa Cruz with permission from my professor. The topic is so relevant to this blog, and something I'm so interested by, that I wanted to share it here.
INTRODUCTION AND POSITIONALITY
Whenever I doubt my uniqueness, I remind myself that instead of being one in a million, I’m actually one in eight million: the eight million men and women in the United States who are battling an eating disorder, that is. (Anorexia Nervosa and Related Eating Disorders). At age 14, I was diagnosed with anorexia nervosa, and four years, a hospital stay, and hundreds of hours of therapy later, I’m still navigating what it means to pursue recovery from the remarkably complicated and largely misunderstood disease. One of the only ways I’ve been able to come to terms with my diagnosis, and begin to find some relief from the habits and thoughts that controlled my life for years, is through writing. For two years now, I’ve been writing about my journey of overcoming an eating disorder on a personal blog, sharing the lessons I’ve learned and the setbacks and triumphs I’ve had along the way. My blog, however, is only one of countless blogs, websites, and social media profiles centered around eating disorder recovery that exists today, and each one takes on its own unique perspective and ideas on what true recovery is and how to achieve it.
For a long time, mental illness has existed in the shadows as a taboo topic not to be discussed in public. Many sufferers of mental illness (and in particular, eating disorders) are silenced by social norms and expectations, feeling stifled by stereotypes that label them as defective, shameful, or even deceitful. In fact, eating disorders weren’t recognized as a legitimate form of illness by the majority of health insurance companies until Congress passed the first-ever eating disorder legislation in December of 2016 (National Alliance on Mental Illness). With such an intense pressure to keep struggles with mental illness private, it’s no surprise that the increasing popularity of social media platforms and online communities has encouraged an increasing amount of discussions on eating disorder recovery to move to an online (and often anonymous) world, creating a unique form of “eating disorder culture” in the process.
But with so many blogs and social media accounts available online, can it be guaranteed that all of them are conducive to recovery from the disease? Some have been accused of perpetuating eating disorders, while others have competing ideas about what recovery is and how to achieve it. By exploring several online “subcultures” of the online eating disorder culture, I will attempt to better understand how they operate, who participates in their communities, and present the differing opinions on their efficacy as tools for patients recovering from eating disorders through both primary and academic sources. This explorative research will ultimately seek to answer not if these communities are “good” or “bad,” but rather to unpack their components and reveal the ways in which patients and their treatment teams can decide which online communities are best for them and their healing process, if any at all.
To understand the online eating disorder culture, it is first important to understand what eating disorders are. According to the National Institute of Mental Health (NIMH), eating disorders are a range of mental illnesses that include extreme obsessions with body weight or shape, food, and oftentimes exercise. Although it’s a common misunderstanding that eating disordered behaviors are a lifestyle choice, in actuality eating disorders are oftentimes fatal mental illnesses brought on by a highly complex interaction of genetics, environmental factors, and behavioral predispositions that experts are still seeking to better understand. Eating disorders exist on a broad spectrum of type and symptoms, ranging from anorexia nervosa (extreme restriction of food intake), to binge-eating (compulsively consuming vast amounts of food in secrecy), to bulimia (bingeing before purging through over-exercise,self-induced vomiting, or other means), to orthorexia (an extreme obsession with eating only “pure” and healthy foods) (NIMH).
A symptom that affects sufferers of all eating disorders, however, is a preoccupation with food, body image, and other sufferers of the disease (National Eating Disorders Association [NEDA]). I can personally attest to this obsession: in the time right after my diagnosis, I spent hours pouring over any online resource I could find on the topic of eating disorders. During a time where I felt lost and confused, I found solace in the lists of symptoms that put a name to the “craziness” I had been feeling inside. As I navigated the waters of recovery for the first time, I became obsessed with the blogs and writings of other sufferers who claimed to be recovered, seeking advice and answers in their words.
Looking back on that time, however, I can now see instances where what I was reading wasn’t helping me heal. Some blogs that claimed to be written by recovered individuals would still display extremely disordered behaviors, just framed in a way that appeared less blatantly disordered. According to Emily T. Troscianko, Ph.D., it is common for eating disordered individuals to, throughout the process of recovery, “switch” from one type of eating disorder to another (Where Next After Anorexia?). A common example of this phenomenon is someone diagnosed with anorexia nervosa taking on orthorexic tendencies in an attempt to rid themselves of their anorexic habits, or to frame them in a different light in order to ease the minds of concerned family members or doctors. This could look like obsessively choosing to eat only low-fat or low-calorie foods under the guise of attempting to be healthy (orthorexia) in order to disguise previous habits of limiting caloric intake to levels of starvation (anorexia).
Looking back on many of the blogs and social media accounts I used to revere as idols of recovery, I now see them as examples of this phenomenon of “switching,” and as people offering advice they may not be credible enough to give. Many of these blogs were written by young girls who often posted side-by-side pictures of their emaciated, disordered frames contrasted with their “recovered,” yet still very thin and conventionally beautiful, bodies in a way that promised their followers a way to recover, while still achieving the body type their disorder had been chasing all along. Seeing how successful these women were- both at recovery and in the popularity they received within the community- made me idolize them in a way that made me desire to look and behave like them. It’s because of this that I believe young people, made vulnerable by their mental illness, could be chasing a different form of perfection modeled after these “idols” of recovery due to the strong emphasis on the bodies of the women running the blogs or accounts.
However, some of the online communities I was drawn to were extremely positive influences on my recovery, and encouraged me to seek health completely unrelated to my appearance. These blogs and social media accounts focused far less on how they ate, what they looked like, and how they exercised, but instead focused on personal growth, mindfulness, and body acceptance as opposed to body manipulation. Inspired by these blogs, I started my own, which exemplifies my belief that not all components of the online eating disorder culture is detrimental. Because I remain firm in my belief that many online resources serve to hinder recovery in vulnerable patients clinging to behaviors, but also write what I consider to be a positive resource for the same community, I believe the “eating disorder culture” cannot be understood as a whole, but rather better understood by its parts. For this reason, I will break down the culture into four distinct sub-cultures- the Pro-Ana community, the “Fitspo”/Bodybuilding community, the Vegan community, and the Body Positivity community. In doing so, I will attempt to shine light onto the possible complications, as well as benefits, that they offer to those seeking recovery from an eating disorder.
The oldest and most infamous online eating disorder subculture is the Pro-Anorexia/Pro-Bulimia community (often referred to as “Pro-Ana” and “Pro-Mia,” respectively) (Elad Yom-Tov, et al). These personal blogs began on online forums and gained popularity on the blogging website Tumblr, but have since moved to other platforms such as Instagram, Twitter, and Blogger. On these websites, sufferers (usually young women) join together to support and promote eating disordered behaviors such as starvation, over-exercise, and purging as a lifestyle choice. Many participants in this community seek out accountability partners, who encourage them to restrict their calories and lose as much weight as possible. A 2014 study refers to this practice as seeking a “pro-ana buddy” (Elad Yom-Tov, et al, 198). This practice is particularly troubling as it feeds a defining characteristic of eating disorder patients- extreme perfectionism and competitive drive - and could easily worsen the symptoms of a patient (NEDA).
A longform article published by Telegraph titled “Secretly Starving: Inside the Virtual World of Anorexia” revealed some of the behavior that takes place within the community through the words of the users themselves. One user is quoted as writing on their blog, “I eat three meals a day but make sure I never take in more than 50 calories,” and another as writing, “I’ve reached a point where I can go without food for three or four days and I am able to live my life with no problems. You can do it too, but it will take discipline and hard work” (Rainey). This kind of language not only describes behaviors that are far too extreme to be considered normal eating or dieting patterns, but also actively encourages readers to partake in them, as well. Specifically, the writer implying that starving oneself is merely a sign of “discipline and hard work” implies that symptoms of mental illness are completely within the control of the sufferer, as well as being positive and desirable attributes.
Another large focus of the community is the distribution of “thinspiration,” photos that idolize extremely thin and oftentimes visibly emaciated women, which are seen as aspirational for the participants of the community (Elad Yom-Tov, et al, 196). These photos often focus on certain body parts the community has deemed as desirable, such as protruding collarbones and hipbones (fig.1). Once again, this practice feeds into the competitive nature of eating disorders, and can easily push viewers to go to further and further extremes with their diet and exercise in order to achieve incredibly thin frames.
Figure 1: Example of “Thinspo/Thinspiration,” displaying specific body parts that are deemed as aspirational by the community.
(“Living Ana Files”)
Because of the promotion of such mentally and physically unhealthy behaviors, many websites have begun to actively seek to eliminate these communities from their platforms. In 2012, Tumblr instated a new policy that would ban all blogs found to promote self-harm, including Pro-Ana/Mia blogs, due to many users who expressed concerns that the presence of such communities triggered unhealthy behavior in mentally ill individuals (Tumblr). Later in 2012, TIME Magazine reported that social media sites Instagram and Pinterest would be following suit, banning any posts tagged under “proana” or related hashtags, quoting Instagram as saying, “Instagram is not the place for active promotion or glorification of self-harm” (Instagram, via Hasan for TIME).
Due to its obvious promotion of disordered behaviors that has resulted in their banning from multiple websites and platforms, this subculture cannot be considered a healthy resource for those seeking recovery. While some argue that it’s important to offer a place for those suffering with mental illness to convene and offer support to one another, this particular community does not offer support, but rather an unhealthy influence on those struggling with an oftentimes fatal disease. Not only do these websites promote behaviors such as starvation, they also promote ways to hide these behaviors from doctors and family members, such as “wearing weighted wristbands when you’re going for weigh-ins or downing three-litre bottles of water to fill you up,” increasing the likelihood that they will not receive the support they need to truly recover (Rainey). I would argue that this is the only subculture that can be clearly labeled as not only unhelpful for those in recovery, but blatantly harmful.
THE “FITSPO”/BODYBUILDING COMMUNITY
Similar to the “thinspiration” that dominates the Pro-Ana/Mia communities, “fitspiration” (which is often shortened to “fitspo”) is another form of aspirational imagery that could be potentially triggering for those in recovery from an eating disorder. Fitspo - unlike thinspo, which displays extremely thin and emaciated women- is made up of photos of physically fit and conventionally attractive women, usually accompanied with motivational slogans that oftentimes prey on insecurities (for example, “Suck it up now and you won’t have to suck it in later”) (fig. 2).
Figure 2: Example of “Fitspo/Fitspiration,” featuring an “aspirational” body type with “motivational” language.
(“Why Fitspiration is Ruining Your Motivation”)
Unlike the Pro-Ana/Mia communities, the Fitspo Community does not align itself with eating disorders in any overt way, and they do not openly express support for disordered behaviors such as purging or starvation. However, these images can still have an extremely damaging effect on the psychological well-being of the viewer, particularly one suffering from an eating disorder. In February 2017, Huffington Post reported that 1.8 billion fitspo photos are uploaded to Facebook and Instagram every day, and that 64% of women feel “significantly worse” about themselves after viewing these images (Herstitch). The psychological distress these images cause can have even greater consequences for someone who comes to the community in attempt to receive advice for their eating disorder recovery; for a patient that experiences negative feelings about their body, seeing images that present a certain body type as desireable paired with messages that imply achieving such a body is important can trigger them to partake in disordered behaviors such as overexercise and underconsumption.
The Fitspo community is closely tied to the Bikini Bodybuilding Community that largely exists on the photo-sharing app Instagram. Bikini is a category of bodybuilding competitions that has a very specific ideal body type: toned, but not overly muscular, with large glute and shoulder muscles, and slender waists and hips. These competitions are the International Federation of Bodybuilding and Fitness’s attempt to “rebrand” bodybuilding into something more desirable, “sexier,” and less associated with the public’s perception of bodybuilders as steroid-ridden, monstrous beings (Shapiro). The Bikini Bodybuilding Community gained traction on Instagram perhaps as a natural progression of fitspo, as it provided an endless stream of “fitspirational” images uploaded to the app every day (fig.3).
Figure 3: Examples of posts under the “Bikini Competitor” hashtag on Instagram, displaying idolized or aspirational body types.
The images shared, however re-branded as healthful, maintain similarities to the Pro-Ana/Mia blogs and posts. Nearly two million pictures can be found under the hashtag “#BikiniCompetitor,” comprised of pictures of women working out or posing in bikinis, food carefully weighed and measured, and quotes encouraging hard work and effort (Instagram, 2017). Although none of these images promote blatantly eating disordered behavior such as purging, these images do promote a certain body type and behaviors that could be taken to an extreme by someone already prone to food restriction and overexercise. It’s interesting to note that many of the women participating in these competitions share in the bios on their pages that they are “‘recovered’ from disorders like bulimia and compulsive exercising” (Shapiro). This begs the question: how many of these women are truly recovered, and how many of these women are merely expressing their disordered behaviors in ways less overtly concerning to those only aware of the behaviors Pro-Ana/Mia blogs explicitly promote? Could they be exhibiting the phenomenon of “switching?”
In a 2009 study focused on the relation between bodybuilding and disordered eating, it was found that “body dissatisfaction, weight and shape preoccupation, strict dieting and vigorous exercise, binge eating, anabolic steroid use and a history of bulimia nervosa was highly prevalent” in bodybuilding competitors (Goldfield, pg. 207). This conclusion suggests that those with a history of disordered eating are drawn to the world of bodybuilding, perhaps because the subculture provides a more socially-acceptable medium through which they can express the obsessive behaviors and desire for control over food and body weight that eating disorders create. The study also found it to be a possibility that bodybuilding could lead to binge eating disorder (BED), citing “dietary restraint theory” as a predictor for bingeing after severely restricting food intake in order to lower body fat before a bodybuilding show (Goldfield, pg. 206). A possible example of this phenomenon is Ruthie Harrison, a bikini competitor, who was quoted in a 2015 Buzzfeed article as saying she was encouraged by fitspo images to partake in the sport, only to find that it led to the development of bulimia. She reported competing in the 2012 Olympia bodybuilding competition in the midst of her disorder, during a time where she was “eating and throwing up seven times a day” (Shapiro). Harrison is only one of many men and women who have experienced similar experiences with disordered eating closely linked to their participation in the Bodybuilding Community.
Idolization of members within the Bodybuilding Community are common, and sometimes problematic. In February 2015, a prominent member of the bikini fitness/fitspo community came under criticism for her alleged exploitation of disordered followers. Brittany Dawn, who has 400k followers on her fitness account “Brittany_Dawn_Fitness,” was the subject of a blog post by another member of the community titled “The Most Disturbing Thing Happening in the Fitness Industry.” In the post, Dawn, who has been vocal about her own struggles with anorexia, is accused of advertising exercise and nutrition plans to eating disorder patients that prescribe “upwards of two plus hours of working out a day, five to six days per week,” and meal plans “that were 1300 calories” a day (Campbell). Campbell also accused Dawn of promoting psychologically unhealthy behaviors, such as never having “cheat” meals of junk food or desserts, behavior reminiscent of eating disordered food restriction. According to the Centers for Disease Control and Prevention, two and a half hours of exercise is what is recommended per week for a healthy adult, and the average amount of calories necessary to maintain a healthy body weight for an active individual is 2,200 calories- vastly different from what Dawn, a certified personal trainer, is accused of prescribing (CDC), (CNPP), (Campbell).
Campbell points out that Dawn has a near-celebrity status within the community, and by advertising herself as someone who has overcome an eating disorder and is now healthy, she is promising her followers (intentionally or unintentionally) that by purchasing her training services, they will enjoy the same results. Dawn, however, stands by the value of her services, writing in a blog post of her own, “Training saved my life. It has, and still does, teach me that I can make my body into anything that I want it to be, through healthy, realistic and practical means” (Dawn). Because of her close alignment with the eating disorder community, however, it appears to be important for Dawn to be aware that much of her clientele will be comprised of recovered or recovering patients, and that her popularity offers her a great amount of influence over their choices and perception of what “healthy living” is. If the accusations being made against her are true, Dawn could be prescribing sick patients exercise and diet plans that could make them even sicker, both mentally and physically.
While many have brought up concerns that the bikini fitness and fitspo communities promote behaviors that could be triggering for a person in recovery, or who is predisposed to developing an eating disorder, there is an equally vocal group that says this community is a healthy counter to Pro-Ana/Mia communities. Advocates say this subculture is opening the once male-dominated sport of bodybuilding up to women, and empowering them to partake in a sport that isn’t traditionally feminine. Where some have drawn parallels between fitspo and thinspo, others consider fitspo to be an “antidote” to thinspo, encouraging women to pursue body types that are muscular and fit as opposed to thin and emaciated (Shapiro). Whatever it is these bikini competitors are promoting, they are reaching a large audience, with popular accounts reaching upwards of 100k followers on Instagram and thousands more reposts on Tumblr and Pinterest (Instagram, Tumblr, Pinterest). Depending on the consumer and their history with disordered eating, their message could be taken as one against anorexia and starvation in favor of fitness, or as one that promises a new way to practice restriction and other disordered behaviors.
THE VEGAN COMMUNITY
Veganism is a diet that excludes all animal products, including red meat, poultry, sea food, eggs, honey, and dairy products (Mądry, et al, pg. 209). Vegans, similarly to vegetarians, may choose to partake in the diet for health, environmental, or ethical concerns, and oftentimes a combination of the three. The diet has a strong online presence, in the form of blogs, message boards, and social media accounts. One of the more popular sites, “One Green Planet,” actively encourages vegans to use the internet as a way to connect with other vegans. “In this digital age,” their website’s homepage declares, “The internet is a great place to get your questions answered and connect with other vegans” (“Finding Community”). Many followers of the diet post pictures of their food on Instagram in elaborate and carefully arranged fashions, promoting the health benefits of the diet and encouraging their followers to give it a try (figure 4). Some of these accounts have hundreds of thousands of followers on Instagram, providing them with large audiences of what sometimes feels like adoring fans (Instagram, 2017).
Figure 4: Examples of carefully stylized food pictures in the vegan community. (Koestler)
Much like the Fitspo/Bikini Bodybuilding Community on Instagram, the vegan community is filled with users who claim to be in recovery from an eating disorder. On an online message board dedicated to raw veganism (a variation of the vegan diet where one consumes only raw fruit and vegetables, as well as seeds and nuts) called “The Rawtarian,” a user posing the question, “How many of us ended our eating disorder by going raw?” received many responses indicating that they were using raw veganism as a way to recover from the mental illness. One user wrote, “I would recommend a low fat raw vegan diet to anyone struggling with disordered eating,” and another, “Going raw saved my life. My ED almost killed me” (The Rawtarian).
On the same board, however, users also warned against the use of raw veganism to heal from an eating disorder. “Be careful that compulsive behaviors do not manifest themselves in a new ways through the raw lifestyle,” wrote one user, “Raw food is certainly healing food, but the emotional and ingrained behavior patterns that go along with eating disorders can translate into any way of eating and need additional resources” (The Rawtarian). This user appears aware of the fact that the restriction necessary to participate in the raw vegan diet could be triggering for those struggling with eating disorders; however, far more users promoted the use of raw veganism as a recovery tool than those who warned against it, increasing the likelihood that a recovering eating disorder patient seeking help online would be encouraged to attempt the diet.
Although the nutritional merits of the vegan and raw vegan diets have been long debated, it’s largely recognized by eating disorder specialists that those with a history of disordered eating should avoid any diet that requires strict eliminations of food groups, as they tend to promote restrictive behaviors (NEDA). There is also a possibility that the switch to a vegan diet, however well-intentioned, can develop into orthorexia, an eating disorder that causes the sufferer to obsess over only consuming foods perceived to be “clean” and exceptionally healthy (Pizzo). Marci Evans, a registered dietitian who specializes in treating eating disorder patients was interviewed in an article on the risks of pursuing veganism in recovery, and reported that most eating disorder clinics will actively discourage the following of the diet for this reason. “If my client was looking to pursue veganism,” said Evans, “I would encourage them to explore their motivations for veganism as it does exclude many foods from the diet and requires a fair degree of extra food planning and vigilance to maintain” (Pizzo). Evans also brings up the point that veganism can make social eating difficult, and give a patient an excuse to cling onto another symptom of an eating disorder: isolation.
Quite a few vegan bloggers have been open about their experiences with eating disorders, however they have done so in very different ways. One popular Instagram user, Hannah Koestler, who goes by the username “ProsperousHealthyLife,” was featured in the Daily Mail for her recovery from anorexia. The article states she was “days away from death” before being hospitalized for her disorder, and later took up a vegan diet in her recovery (Blott). Since then, she has shared pictures of her elaborate vegan meals, as well as photos of her body before-and-after recovery, to her 120k+ followers in the hopes that they, too will find healing through the vegan lifestyle. “I will continue to post pictures of my anorexia battle and healthy meals. To know that I've helped just one person online makes such a difference,” Koestler is quoted as saying in the Daily Mail article, displaying her belief in the positive benefits of the online Vegan Community for sufferers of eating disorders.(Blott).
Completely opposite of Koestler is Jordan Young, who runs the blog “The Balanced Blonde,” where she once wrote about her vegan lifestyle. In 2014, Young received a large amount of online attention for her post titled, “Why I’m Transitioning Away From Veganism,” in which she detailed the physical ailments she’d developed as a result of her diet, as well as the disordered habits she’d developed during the time she’d followed it.
“I started living in a bubble of restriction.” wrote Young, “Entirely vegan, entirely plant-based, entirely gluten-free, oil-free, refined sugar-free, flour-free, dressing/sauce-free, etc., and lived my life based off of when I could and could not eat and what I could and could not combine.” The feelings of restriction Young describes are diagnostic symptoms of anorexia nervosa and orthorexia, which she is here at least partially attributing to her following of the vegan diet, and perhaps her participation in the Vegan Community (NEDA).
Since separating from veganism, Young has been vocal about finding balance with food, and has been featured in multiple magazines and newspapers, as well as writing a book on the subject titled Breaking Vegan. However, Young is only one out of many blogs, websites, and social media accounts that promote veganism as a cure to eating disorders. While some, such as Koestler, appear to have at least physically recovered from their disorder through the use of veganism, others have found it to have exacerbated their symptoms. Depending on the severity, type and nature of the disorder, sufferers will respond to these contradicting voices in the community differently. According to Evans, patients fairly deep into the recovery process may be able to partake in veganism healthfully with extreme caution and the guidance of a doctor, but those looking for a way to fulfill their compulsions to eat only “pure” and extremely healthy foods may find content in the vegan community triggering (Pizzo). Due to their popularity, however, community idols such as Koestler could encourage patients to follow the vegan diet, whether or not it is helpful for their specific context.
THE BODY-POSITIVITY/PRO-RECOVERY COMMUNITY
The final subcommunity of online eating disorder culture is the Body-Positivity and Pro-Recovery community. The antithesis of the Pro-Ana/Mia community, this community openly speaks against eating disorders, and promotes awareness of mental illness and the importance of mental health care. The majority of participants in the community fall into two groups: those who have suffered from an eating disorder in the past, and are now encouraging others to find their own path to recovery, and those who are currently suffering and seeking advice. This unique power dynamic is very clearly defined between those who are recovered and those who are recovering, and leaves those who are recovered to be hailed as “heroes” or “inspiration” by those who look to them for help. Many popular figures in the community run blogs or Instagram accounts that have hundreds of thousands of followers, many of which are left vulnerable by their eating disorder and likely to see these figures as role models for an ideal recovered life. This dynamic, of course, could be positive or negative depending upon the advice being offered by the popular participants, and whether or not they are as recovered as their public image makes them appear to be.
Participants in this community who are active on Instagram oftentimes share photos of their bodies that they believe help sufferers of eating disorders gain a better perspective of what “normal” bodies look like, as opposed to the bodies often promoted in popular culture and media. Megan Jayne Crabbe, who runs an account that features such images with nearly 700k followers, has been highlighted by several news outlets for her voice in the community, including a 2015 Huffington Post article titled “How Former Anorexia Sufferer ‘BodyPosiPanda’ is Inspiring Body Positivity.” In the article, Crabbe is lauded for her postings of before-and-after images that show her at the height of her struggle with anorexia, contrasted with her in recovery, visibly heavier in weight and smiling (fig. 5). The article states that Crabbe’s work helps increase the diversity of representation of body types, and can help prove to sufferers of the disease that happiness can come in any shape or size. Notably, Crabbe directly references social media’s usage as a recovery tool in the article, saying, “Fill your social media up with a plethora of perfection. Find the plus size models and the body positive activists,” suggesting that doing so will help viewers improve their self-esteem and chance at recovery (Hinde). Crabbe also refers to herself as “fully recovered,” which exemplifies the power dynamic within the community between the idolized, recovered members and the sufferers who look up to them (Hinde).
Figure 5: Example of a post by Megan Crabbe.
As pointed out in a Buzzfeed article from the same year titled “Meet The Teen Girls Using Instagram To Recover From Anorexia,” another large focus of the community is documenting the diets of members. Ashleigh Ponder, one of the teens interviewed for the article who uses Instagram as a recovery resource, is quoted as saying, “I took a picture of everything I put in my mouth and made a collage at the end of each day to see what I had. I’d think, Wow, that’s not a lot at all” (Krishna). This kind of behavior is fairly common within the community: using images posted on the app as a kind of journal meant to keep users accountable to their followers to eat enough food to maintain or reach a healthy body weight. While these images may help users feel more motivated to eat, there is also the possibility that knowing their photos will be viewed by other users will add an element of competition to the community. Popular Instagrammers oftentimes put a great deal of effort into making their pictures look “as fresh, clean, and appealing as possible,” which could exacerbate a patient’s compulsive desire for perfectionism and lead to unhealthy comparisons to fellow users (Ladin) (figure 6). One member of the community reported that she would not post pictures of food that didn’t look presentable, and it oftentimes caused her to restrict her diet to photogenic foods or foods that were popular amongst other users- an example of how the subculture could potentially encourage disordered behavior. (Krishna).
Figure 6: Instagram post by ‘Recover4Freedom.'
There are some professionals who believe interactions in the Body-Positivity and Pro-Recovery community could be beneficial to members. Dr. Tony Jaffa, an adolescent psychiatrist, believes that young users who have shared or similar experiences will be better able to provide support to one another than friends or family who have not personally experienced what it’s like to have an eating disorder (Krishna). Media psychologist Dr. Pamela Rutledge echoes this message, while also acknowledging that social media allows sufferers to harness their storyline, and can help them feel more in control of their recovery process. Rutledge also believes that image-based forums of the community, such as Instagram, do not trigger users in the same way that images posted on Pro-Ana/Pro-Mia forums do (Krishna).
There is some evidence to support the claim that following pro-recovery themed accounts on social media such as Instagram or Facebook could aid the recovery process. Cognitive Behavioral Therapy (CBT) is a common form of treatment for eating disorders, and has been recognized as one of the most effective forms of treatment (Fairburn, et al). CBT is a form of psychotherapy that focuses on increasing the patient’s awareness of the relationships between a person’s emotions, thoughts, feelings, and behaviors (NAMI). The intention of CBT is to help a patient become aware of how their negative thoughts could lead to negative or unhealthy behavior in order to prevent them; in the case of an eating disorder patient, this would be disordered behaviors such as restricting food, over-exercising, or purging.
While social media alone is not considered to be a form of CBT, which requires the guidance of a trained professional, the Body Positivity/Pro-Recovery community mirrors many of the elements of the treatment. A study conducted in 2010 showed significant evidence to prove that CBT is effective at treating the main symptoms of an eating disorder: overvaluation of shape and weight, restrictive dietary rules, clinical perfectionism, and low self-esteem (Murphy, et al). These symptoms are largely-discussed topics within the community, often with messages that encourage followers to explore the feelings and thoughts that could lead to having such symptoms: essentially, the methodology of CBT. A popular Body Positivity Instagram user “Gina,” who goes by the username “NourishAndEat,” often posts quotes and messages that promote such mindfulness to her 99k followers. One of her posts reads “No matter what you ate yesterday, you still have to eat today” (fig. 7).
Figure 10: Example of a post by “Gina,” a typical style of image shared in the pro-recovery community. (Gina, courtesy of Instagram)
The message displayed in the image, which received nearly 4,000 “likes,” directly references a negative thought pattern common in eating disorder patients, and encourages the viewer to re-evaluate it. Like CBT, a patient is confronted with a negative thought they may have (in this case, it is implied that the thought would be an obsession with food intake, and the disordered impulse to restrict in order to compensate for previous meals), and encouraged to not engage it (acknowledgement that they still must eat, regardless of what has previously been eaten). Gina also writes in a caption under the image a mantra for the viewer to repeat: “I do not need to compensate, I do not need to ‘balance out’ today. I deserve to eat” (Instagram). The viewer is encouraged by the caption to partake in another element of CBT; mindfulness and repetition (NAMI). Although studies have not been conducted on the efficacy of social media as a form or component of CBT, the links appear to be significant enough to warrant further research.
Finally, I would like to comment on my positionality in regards to the Body Positivity/Pro-Recovery community. Although I do not have hundreds of thousands of followers, I do have a certain level of recognition within the community thanks to a feature of my blog and recovery story on CNN Health in September 2015, titled “Teen Overcomes Anorexia Through Yoga.” In the article, I’m portrayed as someone who is completely in recovery- it’s even referenced in the title. This puts me squarely in the “power” position of the dynamic between the recovered and the recovering within the community. Because of this, I have received countless letters, messages, and emails over the years in response to my blog and the CNN article asking me for the “cure” to anorexia. In essence, it’s assumed that I have all the answers to being a “perfectly recovered” person, which I know does not exist; I still have to actively work on my recovery every day and will always have room to grow.
My biggest concern with this power dynamic and where I am placed within the community is how others will compare themselves to me. Social media lends itself to what I’ve come to call the “highlight reel effect:” people tend to post nothing but the most positive and interesting aspects of their life on social media, which can give viewers a false impression of what someone’s life is like. I have received comments both in real life and online wherein readers of my blog fear they aren’t “as good at being recovered” as I am, which lead me to believe that the highlight reel nature of social media can lead to inaccurately high expectations of how easy or flawless a recovered life is, no matter how positive or uplifting our messages are. Because of this, I am often torn between the comfort and self-growth I’ve gained through writing my blog and reading the blogs of other people, and my unique insight now being on the “idolized” side of the community’s power dynamic.
Although the subcultures that make up the online eating disorder culture are linked by the common thread of a shared form of mental illness, there is a vast amount of variation between them. Each community has its own methods and ideologies surrounding recovery from an eating disorder: the Pro-Ana/Mia community believes recovery is unnecessary, the Fitspo/Bodybuilding community believes exercise and a strict diet can ease disordered symptoms, the Vegan community believes a diet free of animal products is the answer to disordered behavior, and the Body Positivity/Pro-Recovery community believes positive thinking and realistic body type representation will help improve self-esteem and, as a result, help cure eating disorders. Much of the rhetoric within these subcultures contradicts or directly admonishes the ideas of the others, which could leave a patient seeking support online feeling as though they must pick one community to immerse themselves into, almost as though they are picking sides. For some patients, this may be a highly stressful choice that could trigger them to engage in disordered behaviors, such as severe restriction and obsessive following of one community’s “rules,” as a result.
It’s important to once again acknowledge that there are many different kinds of eating disorders, which will impact how helpful each community is to a specific patient. For someone suffering from orthorexia (an obsession with healthy behaviors and “pure” eating), the Fitspo community could trigger them to engage in overexercise, or worse, allow them to justify it. For someone struggling with binge eating disorder (a compulsion to overeat to the point of extreme discomfort), the Fitspo community could inspire them to find a healthy balance between eating well and exercising a reasonable amount. For this reason, it is important for patients to discuss with their healthcare team- preferably both a medical doctor and a trained psychologist- which community is most conducive to their specific needs and symptoms.
As a concluding point, a main symptom of eating disorders is isolation (NEDA). When a patient is truly struggling with an eating disorder, they will oftentimes stop communicating with loved ones and disengage from groups and activities they once loved due to their obsession and preoccupation with food and exercise. In essence, they are silenced by their disorder. For this reason, it feels important to acknowledge the fact that, as a whole, these communities that allow sufferers to actively acknowledge their mental illness, discuss it with others who have an understanding of what they’re going through, and potentially receive support and advice have a great potential to make a difference in the lives of those who are struggling. With the large caveat that choosing which communities to engage with and to what degree is healthy for the individual is essential, it appears that online eating disorder culture has the potential to be a valid support option for sufferers, despite not being a replacement for professional treatment.
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