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Communicating Stigma: The Pro-Ana Paradox
Daphna Yeshua-Katz
a
& Nicole Martins
a
a
Department of Telecommunications , Indiana University
Published online: 08 Aug 2012.
To cite this article: Daphna Yeshua-Katz & Nicole Martins (2013) Communicating Stigma: The Pro-Ana Paradox, Health
Communication, 28:5, 499-508, DOI: 10.1080/10410236.2012.699889
To link to this article: http://dx.doi.org/10.1080/10410236.2012.699889
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Health Communication, 28: 499–508, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 1041-0236 print / 1532-7027 online
DOI: 10.1080/10410236.2012.699889
Communicating Stigma: The Pro-Ana Paradox
Daphna Yeshua-Katz and Nicole Martins
Department of Telecommunications
Indiana University
This study explores the personal experience of pro-ana bloggers, members of an online community
for people with eating disorders. Using Erving Goffman’s work on stigma, this study
explores the motivations, benefits, and drawbacks of blogging about a stigmatized mental illness,
as taken from the bloggers’ own perceptive. We conducted 33 interviews with bloggers
from seven different countries via phone, Skype, and e-mail. Participants were motivated to
blog because they found social support, a way to cope with a stigmatized illness, and means
of self-expression. Participants described blogging as a cathartic experience and perceived the
social support they received from other members of the pro-ana community as a benefit. The
fear that the eating disorder will be revealed if the blog is exposed and the concern that the
blog encourages disordered eating were the perceived negative consequences of maintaining
such a blog. Thus, blogging about anorexia serves to both alleviate and trigger anxiety about
living with this stigmatized illness. Recommendations for future research are made.
I wanted a voice. There was no one in my life that I could
speak to openly about what I was feeling and experiencing.
I wanted to have a voice that I didn’t have to censor for fear
of upsetting people I knew or having them judge me. For me,
writing my blog was the only way I could have a shoulder to
cry on or a way to celebrate my successes. (Billie,1
age 23,
living with an ED)
This comment from Billie provides a glimpse of what it
is like to live with an ED. More specifically, it illustrates
why some people diagnosed with an ED choose to blog
about their experience. Most of the literature that guides
our understanding of ED assumes that the only course of
action for patients is a cure. Given the high mortality rate
of anorexia and bulimia (American Psychiatric Association,
2010) it is no surprise that embracing the illness as a way
of life is often met with anger, sadness, and disapproval
among the patient’s friends and family. As a result, individuals
who live with an ED readily turn to the Web to find
social support. The purpose of the study is to explore the
motivations, benefits, and drawbacks of blogging about a
1Pseudonyms are used to protect the participants’ identities.
Correspondence should be addressed to Daphna Yeshua-Katz and
Dr. Nicole Martins, Department of Telecommunications, Indiana University,
Bloomington, IN 47405. E-mail: dyeshuak@indiana.edu, nicomart@
indiana.edu
stigmatized mental illness, as taken from the bloggers’ own
perceptive.
EATING DISORDERS AND THE PRO-ANA
PHENOMENON
The three most common EDs are categorized by voluntary
starvation (anorexia nervosa), binging and purging (bulimia
nervosa), and binging without purging (binge eating disorder).
The National Association of Anorexia Nervosa and
Associated Disorders (ANAD) (2010) reports that EDs affect
over 11 million people in the United States and are more
common among females. EDs can have significant and
sustained impact on one’s health and have the highest mortality
rate of any mental illness (Birmingham, Su, Hlynsky,
Goldner, & Gao, 2005). Indeed, most patients never fully
recover (Herzog et al., 1999).
Although there is some debate as to whether ED is a mental
illness (e.g., Garner & Garfinkel, 1980; Garner, Garfinkel,
Schwartz, & Thompson, 1980), we contend that it is. People
who live with anorexia nervosa or bulimia nervosa are not
living with a trivial body image problem. On the contrary,
anorexics lose between 15 and 60 percent of their original
body weight, and this weight loss is associated with
osteoporosis, irregular heartbeat, and in extreme cases, death
(Whelan, 2001). As a result, all three types of disordered
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500 YESHUA-KATZ AND MARTINS
eating are recognized as a mental illness in the forthcoming
Diagnostic and Statistical Manual of Mental Disorders
(DSM-V) (ANAD, 2010).
The fact that disordered eating is such a solitary and isolating
experience makes the Internet an ideal place for offering
support and advice. There are many websites that offer
support to those who are trying to overcome their illness.
However, there are just as many online resources that support
the eating disordered lifestyle. Known as pro-ana (for
pro-anorexia) or pro-mia (for pro-bulimia) websites, many
of these sites proclaim that anorexia is a lifestyle choice and
not a disease (Lipczynka, 2007). Norris, Boydell, Pinhas,
and Katzman (2006) found that the site administrators are
mostly female adolescents, and in some cases, younger than
18 years. These online resources provide places for “anas”
to receive support, share experiences, and offer encouragement
(Harshbarger, Ahlers-Schmidt, Mayans, Mayans, &
Hawkins, 2009). More specifically, pro-ana sites provide
specific instruction for initiating and maintaining anorexia
nervosa (Mulveen & Hepworth, 2006). Emotional support,
photo galleries (e.g., usually of thin models but occasionally
of users’ own bodies), poetry, and song lyrics reflecting
the experience of anorexia and related conditions are also
common features of these sites (Norris et al., 2006).
These websites and blogs have been met with public
vilification. Health professionals caution that such sites
may act as a trigger for vulnerable individuals and encourage
disordered eating behaviors (Giles, 2006). Complaints
from ED support groups, parents, and the media resulted in
Internet service providers shutting down many pro-anorexia
websites. The blog hosting service Tumblr announced on
February 23, 2012, that blogs that promote self-harm, like
eating disorders, will be banned from its platform (Ryan,
2012). However, an online search of “pro-anorexia websites”
quickly reveals that these site administrators and bloggers
are resilient, having set up a new site and/or blog under
a different name. This resiliency is presumably due to the
much-needed support that these forums provide (Gavin,
Rodham & Poyer, 2008). Indeed, Davis (2008) argued that
pro-ana websites give patients “support and a sense of relief
and understanding” (p. 97) in that they are not alone in coping
from this disease. Thus, it seems that pro-ana websites
and blogs are here to stay.
The extant research that examined the pro-ana phenomenon
consisted of content analysis of the websites themselves
(Dias, 2003; Lipczynka, 2007; Mulveen & Hepworth,
2006; Norris et al., 2006) or has examined it from a single
user’s perspective (Davis, 2008). To our knowledge,
published studies did not approach the authors directly.
Therefore, the assumption that we know what being pro-ana
means without interviewing the bloggers themselves might
be misguided. Recent evidence supports this idea. Brotsky
and Giles (2007), for example, covertly observed participants
in a pro-ana community. The authors found that this
community does not maintain a consistent standpoint on the
“ana” issue. The results revealed that the answers to why
individuals are attracted to pro-ana sites have little to do with
the need to share a broad philosophy or outlook, and may
stem from the desire simply to belong to a safe community
of individuals with similar experiences.
Therefore, this study does not assume that the pro-ana
community is a homogeneous group of bloggers who share
the same view about their health condition. We employed
in-depth interviews so that we could examine how pro-ana
bloggers understand their experience in their community.
These interviews also allowed us to investigate how bloggers
motivations shaped their digital performance.
STIGMATIZED ILLNESS
Goffman (1963) defines stigma as a “the situation of the
individual who is disqualified from full social acceptance”
(preface). People who cope with a mental illness report deep
and continuous experiences of stigma, marked as tainted and
“less than” (Pescosolido, Martin, Lang, & Olafsdottir, 2008).
As with other mental health illnesses, ED carries its own
stigma. Women with anorexia have been routinely portrayed
as irrational and in denial of their behavior (Dias, 2003).
Mond, Robertson-Smith, and Vetere (2006) found that negative
attitudes toward individuals affected by anorexia nervosa
exist among women, as well as ambivalence concerning the
severity of the disorder. In the United Kingdom, one-third
of survey respondents blamed ED’ers for their condition and
described them as “being difficult to communicate . . . and
empathize with” (Crisp, 2005). Thus, it can be argued that
an ED is a stigmatized illness.
Goffman (1963) also argues that the term stigma conceals
a double perspective: a discredited stigma—the individual
assumes his or her differentness is already known or is visible,
or a discreditable stigma—he or she assumes it is neither
known by those present nor immediately perceived by them.
Eating-disordered individuals possess a discreditable stigma.
Their ED is not visible, kept in secret, and therefore unknown
to everyone else except the individual.
Coping With Stigma
Goffman (1963) recognizes that stigmatized persons strategically
manage the information about their invisible stigma
and referred to this practice as “techniques of information
control.” Goffman (1963) describes information control
as a major issue for those who are discreditable: “to display
or not to display, to tell or not to tell, to let on or
not to let on, to lie or not to lie; and in each case to
whom, how, when and where”(p. 42). Haas, Irr, Jennings,
and Wagner (2010) note that family members of proana
individuals often engage in social conflict over eating
habits. Given that high levels of social conflict result in
low levels of social support, pro-anas may not display ED
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COMMUNICATING STIGMA: THE PRO-ANA PARADOX 501
behavior in front of their family in order to avoid social
conflict.
Social disapproval of disordered eating behaviors may
be a powerful motivator for EDs to go online. In a recent
study, Sundar and colleagues (2007) found that blogging
helped mental health patients cope with their stigma. The
same study also found that participants wanted to educate
and encourage other patients to counteract information
that they believed did not accurately portray their disease.
Similarly, Hu (2009) found that reducing stigma was an
important motivation to blog among her sample of mental
health patients living with depression.
Social support is a multifaceted concept that includes
the ways in which individual well-being and coping are
enhanced by involvement in social networks, the perceived
availability of help and acceptance by others, or the exchange
of tangible and symbolic support in interactions between
people (Albrecht & Goldsmith, 2003). Goffman (1963)
argues that stigmatized individuals in an unaccepting world
may search for sympathetic others who are ready to adopt
or accept their worldview. Such sympathetic others may be
individuals who share the same stigma. These “similar others”
provide the individual with “instruction in the tricks
of the trade and with a circle of lament to which he can
withdraw for moral support” (p. 20). In this case, it can be
argued that pro-anas are able to live with their illness or make
their illness more bearable by going online and finding similar
others who are experiencing the same frustrations and
anxiety that they are.
Social support from similar others has been widely studied
in the health communication literature (Albrecht &
Adelman, 1987; Albrecht & Goldsmith, 2003; Braithwaite,
Waldon, & Finn, 1999; Brashers et al., 2004; Thoits, 1986).
This body of research indicates that supportive others can
assist a stigmatized individual by providing instrumental
assistance, giving emotional acceptance, allowing cathartic
ventilation, or encouraging perspective shifts. Moreover,
it appears that there are different kinds of support that
stigmatized individuals can receive from similar others.
Braithwaite and colleagues (1999) found that persons with
disabilities who participated in a computer-based support
group were offered three types of support: emotional support,
which constituted of sympathy, understanding, encouragement,
and physical affection; informational support,
which constituted situation appraisal; and advice, teaching,
and esteem support, which involved validation, compliment,
and relief of blame. Thus, social support is one possible
motivation for people with eating disorders to join the
pro-ana community.
Another motivation for joining the pro-ana community
may be the anonymity that the Internet provides. Indeed,
Internet newsgroups allow individuals to interact with others
in a relatively anonymous way and thereby provide individuals
with discreditable stigma a place to belong. McKenna
and Bargh (1998) recognize that individuals go online to
meet important social and psychological needs. Their identity
demarginalization model posits that individuals with a
marginalized identity who do not have much social support
offline might turn to an online support group in order
to compensate for the lack of those resources in their “real
life.” These stigmatized individuals can reap the benefits of
joining a group of similar others: feeling less isolated and
different, disclosing a long secret part of oneself, sharing
one’s own experiences and learning from those of others, and
gaining emotional and motivational support. Nevertheless,
supportive communication can contribute positively or negatively
depending on how well people recover from illness
or manage chronic health conditions (Burleson, Albrecht &
Sarason, 1994). Dilemmas of support arise when the benefits
of receiving support are accompanied by costs or
complications.
PURPOSE OF THE STUDY
The pro-ana community is worth studying in its own right
as a social space that affords a style of interaction that
would be highly unlikely to be visible in the offline, or
pre-Internet, environment. Content analysis has been informative
and brought interest in this understudied community,
but has not considered why the users publish their blogs
and how they appropriate the blogs to cope with their illness:
a key focus of this study. Previous research about
the pro-ana community (Hass et al., 2010) has recommended
that researchers establish contact with bloggers to
understand their point of view. Conducting research by contacting
members of the community offers insight into groups
that are normally difficult to access and who are often
misunderstood.
The bloggers are creating their personal space online to
fulfill needs. Those needs might stem from the stigma, or
the social disapproval they face as people who live with a
mental illness. Therefore, Goffman’s seminal work about the
experience of stigmatized people is also relevant in describing
pro-ana’s online and offline behavior. In accord, three
research questions guide this study:
RQ1: What are the perceived motivations of pro-ana
blogging?
RQ2: What are the perceived benefits of pro-ana blogging?
RQ3: What are the perceived drawbacks of pro-ana
blogging?
METHOD
We were interested in studying people who identified themselves
as pro-anas. In order to meet this goal, we sought
out blogs that were clearly pro-ana sites. A blog was considered
pro-ana if it included instruction for initiating and
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502 YESHUA-KATZ AND MARTINS
maintaining anorexia nervosa (Mulveen & Hepworth, 2006),
“thinspiration” imagery and/or photo galleries, or poetry
and song lyrics that reflected the experience of anorexia
(Norris et al., 2006). We searched for pro-ana blogs via
blog-hosting platforms such as blogger.com, Tumblr.com,
and Livejournal.com. Pro-ana blogs were also found through
blogrolls—that is, a list of links to other blogs that the
author of one blog likes to read. To be included in the sampling
frame, the blogs had to be updated at least once in
the past 6 months (e.g., Hu, 2009). Blogs presided over by
mental health professionals, caregivers, or advocates were
excluded.
Once viable blogs were identified, authors were contacted
in three different ways. If a blog provided the author’s e-mail
address, an e-mail inviting the author to participate in the
study was sent directly to him or her. If no e-mail address
was disclosed, we posted an invitation to the study under the
comment page and/or guest page of the blog. Finally, if no
comment and/or guest page was set up, an invitation to participate
in the study was left as a comment to the most recent
blog post. As a result of these efforts, 300 blog authors were
asked to participate.
Participants
Thirty-three female2
participants took part in the study.
Participants in our study ranged in age from 15 to 33 years
(M = 20, SD = 4.5). The length of time most of our participants
reported living with an ED was 6.8 years. Most of our
participants were in high school (n = 16) or attending college
(n = 17). The majority of the participants (n = 22) lived in
the United States, but some were from the United Kingdom
(n = 5), European Union (n = 3), Canada (n = 2), and New
Zealand (n = 1). These proportions reflect world statistics
of where anorexia is most common: in the United States,
Canada, parts of Europe, Australia, New Zealand, and South
Africa (American Psychiatric Association, 2000). The ethnic
breakdown of the participants was as follows: Caucasian
(n = 22), Mediterranean (n = 2), African American (n = 1,)
and other (n = 8).
In spite of our efforts to include only bloggers who
identified themselves as pro-ana (e.g., defining anorexia
as a life style) as described in the published literature,
participants expressed different approaches to their health
condition. Indeed, most of the bloggers (n = 27) reported
living with the disorder but six were in recovery. Twentyfour
bloggers defined their eating disorder as a mental
illness, six bloggers defined their illness as a coping
mechanism, and only three bloggers defined it as a
lifestyle.
2Despite contacting males and females, only females responded and participated
in the study. This is not surprising given that this disease is more
common among women (L. K. George, 1989).
Interview Protocol
The semistructured interview schedule included three sections
of questions. The first section focused on bloggers’
experiences with their ED. The second focused on their
motives for blogging about their ED. Finally they were
asked about the perceived benefits and drawbacks of proana
blogging. A pilot interview was conducted to gauge the
length of the interview and questions progression. Based
on the pilot interview, we revised the protocol to enhance
comprehensibility and completeness.
Procedure
Upon invitation, potential participants e-mailed or called the
researchers to express interest in the study. Participants were
asked to provide their blog web address to ensure that their
blog met our definition of a pro-ana blog. Once a blog was
confirmed, we scheduled a one-on-one interview session or
arranged to conduct the interview over e-mail.3
Before the interview session took place, the participants
completed a consent form and e-mailed it to the researchers.
During the first part of the interview session, the researcher
briefly explained the purposes of the study and asked for
demographic information. Each phone (n = 7) or Skype
(n = 4) interview took approximately one hour to complete
and was audio recorded for purposes of transcription and
analysis. E-mail interviews (n = 23) were also saved for
purposes of transcription and analysis.
Data Analysis
Qualitative methods provide a means of extracting the
meanings that are embedded in people’s experiences, making
them especially worthwhile for new areas of research
(Michallet, Le Dorze, & Tétreault, 2001: Mishel, 1999).
For those reasons we believe that the objectives of our
study would be best met using grounded theory technique.
A grounded theory approach is aimed at constructing theoretical
categories from the data and then analyzing relationships
between key categories (Charmaz, 2006). This
approach allows themes to emerge that are representative of
aspects of the phenomenon of interest (Strauss & Corbin,
1990). As we learned how research participants make sense
of their experiences, we began to make analytic sense of their
meanings and actions. Our goal was to systematically analyze
the accounts that bloggers offered, so that the results of
this study could be an important piece in a grounded theory
of motives, benefits, and drawbacks of pro-ana blogging.
Each transcript was read twice by the authors and coded
using methods of constant comparison (Strauss & Corbin,
3Some participants chose the option of e-mail interviews to protect their
anonymity. The researchers “conversed” with each participant over e-mail
to make sure that all the questions were answered clearly and completely.
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COMMUNICATING STIGMA: THE PRO-ANA PARADOX 503
1990), to identify reoccurring themes and discrete ideas in
the data. Next, we discussed and compared our interpretations
in order to negotiate a series of categories that we
used to give structure to our analysis. We grouped similar
codes into single categories and assigned a conceptual
label to each grouping. For example, “coping with stigma,”
“support,” “receiving tips and tricks,” and “catharsis” were
grouped under the category “motivations for blogging.”
Finally, we searched for representative examples for each
category across all 33 transcripts.
RESULTS
Our results offer insight into the experience of online communication
about an ED, a stigmatized mental illness. In this
section we outline our findings, describing first the motives
to publish a blog, then the perceived benefits of communicating
about an eating disorder, and finally, the drawbacks
of pro-ana blogging. Data from our interviews are offered
throughout as exemplars to illustrate the unique nature of this
online community.
Motives for Blogging
We identified three motivations for blogging: social support,
coping with stigma, and self-expression. We present these
themes according to their frequency in the interviews.
Social support. The major motive for blogging is seeking
social support: Most of the bloggers (n = 22) started
publishing their blog because they did not want to feel alone
and were interested in finding similar others. As Phanny, 16,
describes:
Part of an eating disorder is the loneliness. I was pretty
lonely. I needed someone that would understand. Nobody
“normal” understands why you want to starve yourself for
days on end. Nobody “normal” can understand your frustrations
when you fail and your gleefulness when you can go
through a day of fasting or a day of perfect restricting—only
people like myself would.
Thus, bloggers who felt misunderstood in the offline
environment go online to find social support from similar
others.
The majority of the participants started publishing
their blog to receive the emotional and esteem support
(Braithwaite et al., 1999) that they felt was missing in their
offline environment. The participants reported they are connecting
to a virtual task-related community for support that
constituted validation and affirmation. Bloggers described
interactions with their family and friends as stressful because
they lack the understanding of their situation, while online
they receive support constituted with sympathy, understanding,
and encouragement.
Self-expression. Another motive for blogging was
finding a venue where they can express themselves without
judgment: 16 bloggers mentioned this reason as their motivation
for initiating the blog. Mary, an 18-year-old who is in
recovery, said:
All my friends and teachers and pretty much everyone knows
about it but I can’t go up to them and say “oh, I had a really
bad day today because I ate too much” or “I had a great day
today, I swam miles and miles.” You can’t do that. You can’t
say all that stuff. Online you can say all that stuff ’cause no
one can hold you accountable for that.
Thus, the ability to disclose information to others with less
relational risk is particularly appealing for those who feel
that their ED is strongly stigmatized. Hope, a 15-year-old
who is living with an ED, reports:
The online community provides support that is 100% honest
and true, and nobody feels scared to share their feelings
because there isn’t anyone judging them . . . I think we feel
more comfortable online because we don’t have to expose
our true identity, thus saving the humiliation of friends and
family while still receiving the much needed support.
Hence, bloggers reported feeling safe writing about their ED
without fear of criticism from their offline environment.
Coping with stigma. The third reason participants publish
a blog concerns the stigma associated with an ED.
Indeed, 16 bloggers started their blog to cope with social
disapproval. Lily, 18, who is living with an ED described
the fear of disapproval:
I think it was the fact that having an ED was so socially unacceptable
that it pushed me to seek others that I could tell my
story to. That they would listen and tell me what I wanted
to hear. Even within my own family I couldn’t talk. It was
unspoken, but agreed that if there was something wrong with
you that you hide it.
While the rest of the participants did not mention coping with
stigma as a motive for blogging, they did describe search
for social support as a major reason. When asked to give an
example of how blogging might help cope with stigma, six
bloggers answered that blogging offers them a different reality.
Billie, 23, who is living with an ED, described how her
blog functions:
I often refer to how my blog is my true self and how in
real life I have to act and hide my true feelings. I often call
myself an actress on a stage playing out a part in my real
life. My blog is who I am backstage when I’m stripped of
the makeup and costume.
Thus, by blogging, participants were looking for a way to
escape social disapproval that constructs stigma (Goffman,
1963). Moreover, participants reported they are trying to
control information that might expose their socially unaccepted
attributes by managing discrediting and undisclosed
information. Blog authors reported they did not disclose any
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504 YESHUA-KATZ AND MARTINS
self-identifying information and assigned nicknames to people
in their offline environment if information about them
was included in the blog.
After taking these precautions, bloggers felt that they
could communicate safely about their disorder. As Dias
(2003) suggested, in their blog they discuss taboos in their
offline environment, share experiences, and talk about feelings
of shame and social disapproval. Consistent with other
studies of mental health blogging (Hu, 2009; Sundar et al.,
2007), participants reported a desire to educate and encourage
other patients as a way to cope with an ED. Bloggers
reported that they began blogging “as a way to talk to
people who understand” (Anita, 21, in recovery). Bloggers
expressed their motivation to counteract messages they
believe do not accurately portray their disease. Authors said
they publish their blog to “tell how it is” (Lucy, 26, living
with an ED) and “get rid of shame and try to open people’s
eyes” (Chris, 15, living with an ED). Blanche, an 18-year-old
who is living with ED, describes:
For people who don’t have an ED, it might make them realize
that it’s not what everybody makes it to be. It’s not a choice,
you can’t glamorize it, people die from it and we are aware
of it. We know we are killing ourselves and no matter how
much weight we lose, we’re not going to be happy.
Hence, bloggers repeatedly expressed their opposition to the
image of a community who glamorizes mental illness.
These findings support the notion that for the users the
blog is what Goffman (1959) argues, a “backstage region,”
where performers are present but audience is not. Performers
can step out of character without fear of disrupting the performance.
The bloggers describe their offline daily life as the
“front stage region,” where they act according to conventions
that have meaning to their audience, their family and friends.
Benefits of Blogging
We identified two benefits from blogging: catharsis and
social support. We present these themes according to their
frequency in the interviews.
Catharsis. The majority of the sample (n = 21)
reported that blogging about their ED improves their mood.
It can help me calm down when I am stressed or upset, as the
simple motion of typing out what you feel helps to take you
away from the situation you’re stuck in and concentrate more
easily. Seeing a situation written down somehow makes it
easier to deal with, and so when I’m upset I write down why
I’m upset on my blog. (Grace, 18, in recovery)
Thus, by putting their thoughts into writing, bloggers
reported that they were able to find relief.
Indeed, previous research demonstrates that putting distressing
thoughts and feelings into words can be mentally
beneficial (Esterling, L’Abate, Murray, & Pennebaker,
1999). Displaying their private thoughts to an audience of
supportive others allowed bloggers to find cathartic ventilation
(Brashers et al., 2004). Moreover, participants explained
the difference between writing a journal and publishing
a blog: Once other bloggers started following them, they
became aware that their words are reaching an audience; this
audience soon became their community.
Social support. The second benefit of blogging is to
create a supportive community. Nineteen bloggers describe
their online environment as a place to find similar and supportive
others. Grace, 18, who is living with the disorder,
reported:
I don’t receive much support from friends and family, who
have no idea what I am really going through. My mother
calls me “greedy” when I binge, and my boyfriend praises
me, as he doesn’t realize they are a part of the disorder
no matter how many times I tell him. However, online,
other bloggers tell me that it’s not the end of the world,
they say encouraging things which stop me from wanting to
purge or self-harm, and I know they all understand and have
been there. That gives me hope that I can get through the
binge.
Thus, by participating in the community, bloggers received
understanding, encouragement, compliments, and validation
from their peers.
Bloggers describe the online support as unconditional:
They receive encouragement when they post about their
weight loss success, and comfort in bloggers’ comments
when they fail in such efforts. Moreover, when a user wants
to stop self-harm behavior or go into recovery, the community
supports her choice, too. Ellie, an 18-year-old who is
living with the disorder, reported: “I’ve been doing it for
years and I know the people online well. I receive support
for healthy eating and exercises but I also receive support for
unhealthy eating.”
Our participants perceived the support within their ED
community to be stronger than the support they received for
their so-called strong ties in their offline life. Moreover, the
online weak ties that started by meeting each other online
are becoming strong offline ties: eight bloggers reported that
they met another pro-ana in person. In addition, bloggers
interact with other community members in more ways
than blogging: They text, call, and Skype each other and
become friends on Facebook. Bloggers communicate via
other media to maintain ED behavior but to also receive support
with mundane matters such school exams and romantic
relationships.
This community is also important to members who decide
to go into recovery. Anita, 21, in recovery, described her difficulties
in separating from the online community: “Now, in
recovery, it is harder to find recovery blogs, but the ones that I
read are often more professional. But I still follow some non
recovery blogs, because I feel it’s hard to totally abandon
them.”
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COMMUNICATING STIGMA: THE PRO-ANA PARADOX 505
Finally, eight participants felt that in the pro-ana community
there was no attempt at correction, and no one tries to
“fix” them, as Grace described:
There is a sense of competition when speaking with offline
friends about the ED’s, as it can often be a case of who is
“thinnest” or most “disordered.” Also, it is harder to find
offline communities of people with ED’s . . . it is rare you
find pro-ana group outside. Online, there are no visual attachments
to the people with whom you speak, so it is easier to
converse without feeling threatened and to find people who
understand.
Hence, participants felt that they would encounter a pressure
to recover in an offline support group.
Therefore, the perceived catharsis and social support
provide community members with a sanctuary from their
disorder in an environment that safely allows for true selfexpression.
However, most of these blogs were public, and
bloggers cannot know who reads them. The uncertainty
about their audience is responsible for two unexpected consequences:
fear that their ED will be exposed and concern
that their blog might encourage ED behavior.
Drawbacks of Blogging
Despite the many benefits, most of the participants in our
study (30) discovered that blogging has negative and unexpected
effects. We identified two negative consequences
from blogging: fear of disclosing their ED behavior and
encouraging an ED behavior.
Fear of disclosure. Ten bloggers described fear of
being identified as their chief concern. Elah, 17, described
her blog as “a skeleton in my closet.” Twenty-two bloggers
were concerned that their family and friends will discover
their blog, as Blanche described:
My boyfriend and I are using the same computer and I don’t
want him to come across that kind of information. When I
started the blog five years ago, it was originally public but my
boyfriend saw it back in March and made a big deal about it.
We got into a lot of fights about it and I decided to make it
private.
Hence, despite their efforts to keep their identity anonymous
(e.g., assigning nicknames, concealing personal details),
most bloggers were worried their family and friends will
search their name and find their blog.
The bloggers in this study managed 1.84 active blogs
on average. Ten of the bloggers publish an additional
blog where they don’t mention their ED. Anita, 21, who
was in recovery when the study took place, described
how she used to manage two blogs simultaneously: one
about her ED and the other a “healthy” version of herself.
She described the stressful experience when her blog was
revealed:
I was concerned people I know will visit my blog. I was
afraid that someone will figure out it was me and confront
me in my real life. My sister found my blog because I commented
on her post with my ED account accidentally. She
said “I know it was you, what’s going on?” That was scary, I
was terrified.
Thus, the bloggers engage in what Goffman (1963) describes
as “information control techniques,” intensive efforts to conceal
information about their disorder that result in stressful
experiences.
Encouraging ED. Twelve bloggers in this study were
concerned that the content in their blog might trigger their
own ED behavior, or what Phanny, a 16-year-old, described
as “feeding the obsession.” Bloggers in recovery who disobey
their therapists’ instructions not to visit the pro-ana
blogs describe how they still need to feel a part of a
community. Lilly, 18, reported:
I tend to find the wrong kind of support online. When I don’t
want to get better, and I want permission to keep this up, I go
online. But I do have a friend on the outside that I can always
count on to console me when I feel fat or unworthy.
Thus, bloggers who are trying to recover describe the support
in the online community as a double-edged sword.
Seven bloggers reported finding more support in the
offline environment to get better, by friends, family, or therapists.
They also expressed their concern that their blog will
trigger an ED in people who are vulnerable, such as young
girls and people who are trying to recover from an ED.
It should be noted that all the bloggers issued disclaimers
on their homepages to state that they were not promoting
ED and warned minors not to enter the site. Participants
described their efforts to block young readers who sought
weight-loss advice. Bloggers were aware of the contradiction
between their willingness to share information and their
concern of triggering an ED, as Billie described:
I always worry that impressionable teenage girls (or
younger) who are concerned about their body or weight will
visit my blog and read about my hatred for my body and
take tips or inspiration from my restrictive diet. I would never
want to encourage anyone to start dieting or thinking in the
damaging way that I do.
In addition to the main drawbacks mentioned so far,
12 bloggers expressed different views: Three bloggers mentioned
haters who entered the community and “trolled”
(posted inflammatory messages) as the negative consequences
of blogging. Two were concerned about being
considered as a failure in the community if they did not
lose weight and being labeled as a “wannarexic,” a pro-ana
“wannabe.” In addition, two bloggers found the blog to be
time-consuming and felt pressure to continuously entertain
and provoke readers.
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506 YESHUA-KATZ AND MARTINS
DISCUSSION
The goal of this study was to understand the motivations,
benefits, and drawbacks of blogging about an eating disorder.
We found that participants were motivated to blog because
they found social support, a way to cope with a stigmatized
illness, and means of self-expression. Participants described
blogging as a cathartic experience and perceived the social
support they received from other members of the pro-ana
community as a benefit. In contrast, the fear that the eating
disorder will be revealed if the blog is exposed and
the concern that the blog encourages disordered eating were
the perceived negative consequences of maintaining such a
blog. Thus, paradoxically blogging about anorexia serves
to both alleviate and trigger anxiety about living with this
stigmatized illness.
The results of this study support the idea that participants’
membership in an online community is a result of social and
psychological needs, in this case, a need for emotional and
esteem social support (Braithwaite et al., 1999), coping with
stigma, and finding support from similar others (Thoits,
1986). Our results support McKenna and Bargh’s (1998)
identity demarginalization model, as our participants were
clearly active online in order to compensate for the lack
of resources in their offline environment. These findings
also support what Goffman (1963) describes as the type
of support stigmatized individuals are looking for: Pro-ana
bloggers, as stigmatized individuals, expect support from
those who share their stigma and define themselves as their
own kind.
These expectations to receive support lead to engagement
in blogging, resulting in need gratification such as emotional
and esteem social support and catharsis. As people who cope
with an invisible and discreditable stigma, they express their
painful struggle online in a discrete way (Goffman, 1963).
Their media use can be described in Goffman’s terms as
“information control techniques.” Bloggers conceal their ED
offline and go online to express themselves. In the online
realm, bloggers conceal their true identities and put efforts
into making their information anonymous.
Nevertheless, such media use may lead to unintended
consequences and to what Albrecht and Adelman (1987)
described as dilemmas of support that arise when the benefits
of receiving support are accompanied by costs or complications.
In spite of their effort to keep the blog anonymous,
bloggers do not have control of their audience. Their online
activity may lead to the unexpected consequence of fear that
their blog will be discovered by their family and friends.
Bloggers are also concerned with providing triggering information
to a vulnerable audience such as young girls and
people in recovery.
The findings in this study vary from media coverage and
research about the pro-ana community. The decision to interview
the authors directly instead of analyzing their online
content might be the reason for the differences. As Baym
(2006) argues, if researchers do not interview participants or
have other access to their point of view, they have no grounds
for claims about how online phenomena are understood or
how they influence those who engage in and encounter those
phenomena. Therefore, pro-ana bloggers need to be studied
themselves, instead of just analyzing their online content.
While extant research suggests that the pro-ana community
defines anorexia as a lifestyle (Dias, 2003; Giles, 2006;
Haas, Irr, Jennings, & Wagner, 2011; Lipczynka 2007), in
this study, only three bloggers out of the 33 define their ED in
this way. The majority of the bloggers (24) defined their ED
as a mental illness. In other words, people living with EDs
are not purposely making unhealthy or health-compromising
decisions. They are trying to find the best way they can to
live with this disorder.
While some studies claim that pro-ana websites promote
and maintain anorexia by sharing tips for weight
loss and tricks to conceal the disorder (e.g., Haas, Irr,
Jennings, & Wagner, 2011; Lipczynka, 2007), only five
bloggers mentioned a reason to lose weight and tips and
tricks as a motivation to start publishing the blog. Some
studies claim that the pro-ana community provides specific
instructions for initiating and maintaining anorexia nervosa
(Mulveen & Hepworth, 2006) and that this movement adopts
an “anti-recovery” view of the disease (Haas et al., 2010).
However, participants in this research, except for shutting
down their blogs, did actively engage in ways to warn their
audience about the content (i.e., disclaimers) and ignored
or blocked requests for tips and tricks from what they
nicknamed “wannarexics”—young teenagers who want to
become anorexic.
There are two possible explanations for the differences
between past research and the findings reported in this study.
First, participants who were willing to participate in the
study might be more aware of the criticism in the public
domain; thus, they wanted to defend their community.
Second, previous studies were mostly using content analysis
of the pro-ana blogs and did not approach the authors
directly. Conducting in-depth interviews allowed us to discover
the motivations behind bloggers’ digital performance.
The pro-ana community is providing people who live
with an eating disorder an undisclosed place to express their
thoughts. Their offline environment, family and friends, usually
wish for them to recover. Nevertheless, according to a
number of studies, conventional modes of treatment for eating
disorders are extremely ineffective. For example, those
treated for anorexia have less than a 50% chance of recovery
within 10 years and a 6.6–15% risk of dying 10–20 years
after the onset of symptoms (Bergh & Sodersten, 1998).
Mastronardi (2003) suggests that any other disease with
such a notoriously low recovery rate would warrant fervent
examination of the status quo diagnosis and treatment plans.
Instead, the young women themselves are blamed for sabotaging
their own recovery. Our results suggest, then, that
the moral panic about the websites might not be appropriate.
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COMMUNICATING STIGMA: THE PRO-ANA PARADOX 507
Efforts to censor an outlet for a group who cope with a mental
illness that has no effective treatment might not be the
right step. Instead, efforts should be concentrated in providing
more comprehensive online resources for information
about effective treatment.
Limitations and Future Research
In our study we have addressed the scarcity of literature on
this issue by approaching the community members directly
instead of analyzing their media content. We solicited
community members’ accounts via in-depth interviews to
discover their interpretations of their own online communication.
It is quite possible that our results would differ had
we had the opportunity to compare their interpretation with
their blog content. However, the use of in-depth interviews
is an appropriate starting point for understanding how
members of this understudied community narrate and attach
meaning to their online experience. It is recommended that
future studies will compare the authors’ media content and
their interview data.
The sample presented here is not intended to be comprehensive
and might not be representative of all pro-ana
bloggers. The majority of the bloggers who participated in
the study were living with anorexia, but there are other
bloggers who live with an ED-NOS (eating disorders not
otherwise specified) or bulimia. In addition, most of the
bloggers were living with eating disorders while six of them
were going through recovery. Ideally, the sample should
have included a larger number of patients in recovery to
be able to find whether there are significant differences
between the two groups. However, it is noteworthy that
the experience described by participants seemed to transcend
a specific stage in the illness. Our findings suggest
a commonality among bloggers from different demographic
background that should encourage other researchers to
explore.
Pro-ana bloggers are turning to the Internet to create
and cultivate an online community that offers them support,
acceptance, and self-expression. The Internet has allowed
a new subculture to develop, which allows devotees to feel
part of a community that fully embraces them and their
choices. Online support groups for stigmatized individuals
have yet to be widely studied by communication researchers.
More research on how social support is enacted in these
groups would be particularly useful to those interested in
designing, providing, using, or evaluating online support
as an alternative to face-to-face support. This work might
be particularly relevant to individuals with eating disorders,
who may find face-to-face support especially problematic
due to the challenges of identity disclosure and access to
services. In addition, many family members and partners
of people who live with an eating disorder may find online
support groups useful.
The medical profession has struggled to develop effective
treatments and interventions for addressing self-harm
practices. While the Internet does not provide a solution,
it does introduce new possibilities for leveraging visibility
to learn from and reach out to those who live with an
eating disorder (Boyd, Ryan, & Leavitt, 2011). Therefore,
these findings shed light on the experience of living with a
stigmatized illness and participating in an online community
of similar others.
Understanding the communication strategies and the personal
experience of community members may serve as a
useful tool to assist health professionals and scholars understand
the illness better. By gaining a deeper insight and
listening to the bloggers’ view about their disorder we can
potentially increase our efforts to help those who struggle
with this stigmatized mental illness.
ACKNOWLEDGMENT
The authors would like to thank Avi Katz, Oren PizmonyLevy,
and Florence Katz for their guidance and suggestions
throughout this study.
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