Annotated Bibliography

Up to 24 million people of all ages and genders suffer from an eating disorder in
the United States. Anorexia nervosa, one type of eating disorder, has the highest mortality
rate of any psychiatric illness (Dyke 147). Eating disorders have been studied and talked
about in homes, schools, and medical communities for many years. I am researching the
popularity of the pro-eating disorder movement, which takes form in cyber communities
on the Internet. In the past decade, the World Wide Web has provided us with a new
outlet for creative expression and freedom, a place that has become home to one of the
most rapidly growing movements in recent years. I am hoping to discover what these
sites offer to its members and how they affect their lives and illnesses. In addition, I am
exploring why these Web sites are created and consulted, ranging from more well known
to causes to those that are not as commonly discussed. I would like to investigate the
influence the Internet has had on the treatment of eating disorders and possibly consider
ways in which more effective programs could be created to address the problems that
pro-ana (pro-anorexia) and pro-mia (pro-bulimia) Web sites focuses on.
Borzekowski, Dina L. G., Summer Schenk, Jenny L. Wilson, and Rebecka Peebles. "EAna and E-Mia: A Content Analysis of Pro-Eating Disorder Web Sites."
American Journal of Public Health 100.8 (2010): 1526-534. Academic Search
Premier. Web. 3 Nov. 2014.
This article describes in depth the process and findings of a study that analyzed
characteristics of pro-eating disorder Web sites and the messages to which users
may be exposed. Borzekowski and her colleagues, after studying 180 websites,
which met specific criteria deeming them as pro-eating disorder, found results
revealing the universal publicity of the websites and the frequently reoccurring
pro-mia and pro-ana content, with some focusing on eating disorders as a lifestyle
choice. Nearly all sites used in the study (98%) revealed the site administrator was
female; sixteen percent stated the site was maintained by adolescents and sixty-six
percent by young adults, aged 18-24 years (Borzekowski et al. 1528). The article
confirms with copious data that these types of websites are plentiful on the
Internet and speculates that social interaction is an important facet of the draw of
these sites. This article should be useful for its statistical findings that definitively
point toward the negative effects of viewing pro-ana and pro-mia Web sites on
females of various ages. Its data especially focuses on the characteristics of the
sites that can be seen as dangerous, such as the inclusion of Thinspiration images and prose intended to inspire weight loss (Borzekowski et al. 1529) and
the commonly found themes of control, solidarity, and perfection. It also touches
on the physical and mental consequences of viewing these websites. The source
also adds some information and speculation about the causes of the popularity of
these Web sites, which will undoubtedly be helpful in building the argument and
credibility of my paper.

Delforterie, Monique J., Junilla K. Larsen, Anna M. Bardone-Cone, and Ron H. J.

Scholte. "Effects of Viewing a Pro-Ana Website: An Experimental Study on
Body Satisfaction, Affect, and Appearance Self-Efficacy." Eating Disorders 22.4
(2014): 321-36. Print.
This article reports an altogether different view of pro-eating disorder websites. It
describes a study conducted by Monique J. Delforterie, Junilla K. Larsen, and
Ron H.J. Scholte, members of the faculty of Radbound University Nijmegen in
Nijmegan, The Netherlands, and Anna M. Bardone-Cone, a member of the
Department of Psychology at the University of North Carolina at Chapel Hill.
Their investigation studied 124 normal weight, young adult Dutch women and
their reactions to viewing three kinds of websites, a pro-ana website, a home
decoration website (referred to as an appearance neutral website), and a fashion
website which used average sized models. Their findings suggest that viewing a
pro-anorexia website might not have detrimental effects on body satisfaction and
affect among normal weight young women (Delforterie et al. 321). The report
discussed briefly the common notions of the possible causes of anorexia and
bulimia nervosa. However, after reading this source more in depth, this source
might be better suited toward a report in which one is making a more positive
claim toward the viewing of pro-ana websites. It may provide some possible
useful information in forming a counterargument or addressing another view, but
it does not provide any theories or information as to the sources of popularity of
these Web sites.
Dias, Karen. "The Ana Sanctuary: Womens Pro-Anorexia Narratives in Cyberspace."
Journal of International Women's Studies 4.2 (2002): 31-45. Print.
Approaching pro-ana Web site culture from a decidedly feminist standpoint,
Karen Dias does not spend her whole article attacking the practice of these online
communities; however, it can be inferred that Dias sees these sites as more of a
safe space where sufferers can seek support and encouragement before they are
ready to seek help (31). Dias notably includes the testimony of a recovered
sufferer of an eating disorder when the anonymous woman stated, When I was
going through my eating disorder it certainly would have been comforting to have
people to talk to before I was ready to get help (Dias 38). Dias is notable in her
scrutiny of the media and publics backlash to the existence of these sites, as well
as the rigid criteria for diagnosis and admittance to recovery programs in the
health system, which may be having an adverse affect on the recuperation of those
who suffer. If women fail to meet strict criteria for diagnosis, they are refused

treatment unless they can afford private services, which can lead many girls and
women to avoid seeking treatment for fear of rejection. When they finally meet
criteria, it may, in fact, be too late (Dias 39). An important point of overlap in
Diass piece is the argument that pro-ana communities offer some positive
benefits for users, as noted by Sarah Dyke and Michele Polak. This source will be
helpful with its detailed study of the pros of pro-ana communities and the reasons
in which young women are drawn to the sites.
Dyke, Sarah. "Utilising a Blended Ethnographic Approach to Explore the Online and
Offline Lives of Pro-ana Community Members." Ethnography and Education 8.2
(2013): 146-61. Print.
This article, written by Sarah Dyke, a member of the faculty of the Education and
Social Research Institute of Manchester Metropolitan University in the United
Kingdom, touches on the shortfall incurred by failing to engage with life online
(Dyke 159) that affects the complexity of prevention of eating disorders. Her
research and report are especially interesting because they address the increasing
popularity of the Internet and how it plays a role in the lives of those living with
eating disorders. Her primary audience is other researchers in her field because
she writes, the ethnographic community may do well to become mindful of the
way in which online interactions increasingly become reference points for offline
embodied relationships (Dyke 160). Dyke also includes her interaction with a
young woman with whom she came in contact during her study, and the accounts
of their interaction help develop the search as to why these Web sites are enticing
and how users respond to them. When a favorite site has been taken off the
Internet, Joanne (the young woman) tells Dyke, A bond of trust has been abused,
something of value maybe lost (Dyke 157) This source will be helpful because
of its inclusion of the Internet in the studies as a space for anorexic people to be
validated, feel significant, and get support from people like them (Dyke 148).
Harris, Gregory, & Gary Jeffery. "School Counsellors Perceptions on Working with
Student High-Risk Behaviour." Canadian Journal of Counselling and
Psychotherapy / Revue canadienne de counseling et de psychothrapie [Online],
44.2 (2010): n. pag. Web. 1 Nov. 2014
This article was written by Gregory E. Harris and Gary Jeffery from Memorial
University of Newfoundland. It is primarily written for the scholarly community
and those involved with general and school counseling. It provides details from a
study conducted within Newfoundland and Labrador, which collected data from a
mixture of fifty-two guidance counselors and educational psychologists. The
study was conducted in the form of a questionnaire that asked its participants

about different aspects of their preparedness in handling various issues that

students face including drug abuse, bullying, sexual assault, and eating disorders.
The data and information discussed primarily focused on bullying and drug abuse;
however, Harris and Jeffery noted the majority of participants reported
addressing eating disorder behaviors (Harris, Jeffery). Having said that, the most
shocking thing was the fact that the participants indicated they received very little
or no formal training over the past five years in this area. Having said this, the
main usefulness of this source is this fact, which I will use to broach the topic of
the possible need for reform of programming to address the problem of eating
disorders in young adults, which has been fueled in part by pro-ana Web sites.
Peebles, Rebecka, MD, Jenny L. Wilson, MD, Iris F. Litt, MD, Kristina K. Hardy, PhD,
James D. Lock, MD, PhD, Julia R. Mann, BA, and Dina LG Borzekowski, EdD,
EdM. "Disordered Eating in a Digital Age: Eating Behaviors, Health, and Quality
of Life in Users of Websites With Pro-Eating Disorder Content." Journal of
Medical Internet Research 14.5 (2012): n. pag. Journal of Medical Research.
JMIR Publications, Inc. Web. 2 Nov. 2014.
This article, written by a group of professionals working at universities including
The University of Pennsylvania, Stanford University, and Johns Hopkins
Bloomberg School of Public Health, catalogues a study on the connections
between usage of pro-eating disorder (pro-ED) Web sites, disordered eating
behaviors, and quality of life. The results illustrated the wide use of strict weightmanagement measures from 1291 participants, 97% of whom were female with an
average age of twenty-two years old (Peebles et al). The article touched on the
negative consequences of viewing the sites, including higher body dissatisfaction,
bulimic activity and restriction of foods eaten. In addition, the authors raised the
issue of the need of new approaches to treating eating disorders and getting
people the help they need, a topic also highlighted by Jeffery and Gregory, as well
as Rickard and Strife. This source will be useful in my research and crafting of
my final paper for its specific mention of correlations between use of these Web
sites and eating and living habits of those who use them.

Polak, Michele. ""I Think We Must Be Normal ... There Are Too Many of Us for This to
Be Abnormal!!!": Girls Creating Identity and Forming Community in ProAna/Mia Websites." Growing Up Online: Young People and Digital

Technologies. Ed. Sandra Weber and Shanly Dixon. New York City: Palgrave
Macmillan, 2007. 81-93. Print.
This chapter of Weber and Dixons larger work deals specifically with the
phenomenon of girls, primarily pre-adolescent through young adults, creating
identities and forming communities through pro-ana and pro-mia Web sites. Polak
takes the issue from a rhetorician and feminist perspective and speculates in depth
about the draw that these communities provide. These online texts create
identity, form community, and even encourage recovery among users. (Polak 83)
She describes these virtual communities as a type of virtual bedroom culture
(Polak 83) where girls can be social through the Web and private from the
comfort of their own rooms at the same time. In addition, Polak includes various
draws to the online communities, including them as a place for members to learn
about their illnesses and relate each others stories to ensure a strong sense of
community and identity (Polak 86). She also includes a sort of counter argument
by providing facts that some studies have not found major effects of viewing
these websites, such as no significant differences in weight, bone density, or
duration of eating disorders and questions if deleting the sites off the Internet is
the best approach to dealing with them (Polak 90). This source will be helpful in
my research by providing information for addressing counter arguments,
speculating on causes of the use of these sites, and what these sites offer for its
members.

Rainey, Sarah. "Secretly Starving: Inside the Virtual World of Anorexia."

Telegraph.co.uk. Telegraph Media Group Limited, 2013. Web. 02 Nov. 2014.
This article, published by the British news outlet The Telegraph, is an in-depth
expos that describes the nature of pro-ana online communities and includes
valuable testimonies from both community members and professionals. This
source is primarily aimed towards those directly affected by these websites
mostly parents and those who come in contact with young people who may be at
risk. Rainey highlights several interesting draws to the website, such as the lure of
anonymity and lack of consequences that the digital world provides. The main
feature Rainey describes is the new, virtual life that users can create, including
original nicknames and fake avatars, to assume a new identity. In addition to
presenting information, Rainey takes the same approach as Polak by noting that
simply removing these websites from the World Wide Web may not be the best
approach. Major social networks have attempted to regulate and remove
dangerous thinspiration content that relates to pro-mia communities; however,
their efforts have proved almost completely futile since pictures and content can
be reposted under different names. Raineys point of view is that the only ways to
overcome these dangerous sites is to understand them and recognize what turns
people toward the communities. Dr. Emma Bond, a senior lecturer in childhood

and youth studies at University Campus Suffolk, comments, Its their form of
self expression and you cant shut that down. (Rainey) By the inclusion of
statements from real-life sufferers and professionals, points of appeal to users, and
the issue in exterminating these sites, Raineys report will no doubt come in
handy during my research.
Rickard, Kathryn & Samantha Roberts Strife. "The Conceptualization of Anorexia: The
Pro-Ana Perspective." Affilia 26.2 (2011): 213-17. Print.
This article, written by Samantha Roberts Strife, PhD, of University of Colorado,
and Kathryn Rickard, PhD, of Colorado State University, describes a study of
fourteen websites that took opposite sides of the pro-ana perspective: one group
that viewed anorexia as a way of life and another as a medical issue. It
highlighted the stark differences between the two views and the objectives of
both. Those who viewed eating disorders as a way of life highlighted agency and
empowerment and highlighted the value of control (Rickard and Strife 215). The
article also highlights the fact that the draw to these websites is their aim to foster
empowerment and a false air of control. The report seems to be written for
professionals because it includes clinical implications of the results of the study
and offers tips as to the future treatment and assessment of patients with eating
disorders. This source, for this reason, would be quite helpful in crafting a
proposal for a way to better handle and deal with pro-ana communities.
Rodgers, Rachel F., Sabrina Skowron, and Henri Chabrol. "Disordered Eating and Group
Membership Among Members of a Pro-anorexic Online Community." European
Eating Disorders Review 20.1 (2012): 9-12. EBSCO. Web. 2 Nov. 2014.
This article, written by Rachel Rogers, Sabrina Skowron, and Henri Chabrol,
describes a study whose purpose was to assess disordered eating among members
of a French pro-ana cyber community and to explore the effects of the site on its
members (Rodgers, Skowron, and Chabrol 11). The primary audience of this
source is researchers and scholars who do not know much about pro-ana
communities and the online presence of eating disorders. The study provides a
myriad of facts that support several ideas, such as the patterns of motivation of
use, including the need for social support as well as a source of motivation and
tips for rapid weight loss (10). The source includes specific examples of practices
taken by users, including vomiting, fasting, severe restriction of food, and
drinking excessive fluids to ebb the feelings of hunger (11). This document will
be helpful for its copious amount of statistics gained from the study and
specificity of the participants responses on various topics, such as motivation,
practices, and personal reflections of the experience of being a part of the online
community.